July 30 - Blantyre by night

July 30

You don’t walk around Blantyre after dark. Malawi may be one of the safer and friendlier places on the continent – not especially difficult when you’re dealing with countries the likes of Somalia & Sierra Leone or cities such as Johannesburg & Nairobi – but it’s still not a place to be taken too lightly come nightfall. By 6pm everyone is scurrying along the roads, making driving even more challenging with all the pedestrians by twilight, trying to get home before a curtain of dark envelops the town. Very few streetlights, minimal traffic, poor signposting and a distinct lack of businesses open late means the evening becomes a somewhat lonely affair on the streets. You certainly wouldn’t want to be out alone as a mzungu (‘white person’ in Chichewa, the local language) walking in the dark, that would be asking for trouble.

Yet if you scratch the surface, Blantyre is very much active come night, you simply need to know where to look. Heaving bars hide surreptitiously behind large guarded gates, reasonable and varied restaurants lurk secretively down dark alleyways and there’s always someone having drinks or dinner or something of the like in a private home somewhere. You could fill your social calendar twice over ever night of the week if you accepted every invitation that is thrown your way here. I think we have more on in Blantyre throughout each week than we ever had in Melbourne.

One of the goals for us in our move to Blantyre was to get to know plenty of Africans and to maintain as much of a local influence to our lives as manageable. Something we presumed wouldn’t be too difficult given our single local salary and the vast predominance of black Africans living here. In fact, other than the second generation whites and the expatriate community in Blantyre, there are literally no white Malawians. The problem is that the expat community in this place is huge. Within only a couple of weeks of living here we have rapidly realised that there is something social on within the expat world every single night… and given how much more relaxing it is culturally to spend time with westerners, it becomes quite a trap very rapidly. Hash House Harriers running on a Monday night, volleyball Wednesdays, happy hour at one of the expat bars Tuesdays and Thursdays, live music at the Blue Elephant Bar on Wednesdays, more running on Thursdays, always a going away or housewarming or birthday party Fridays & Saturdays. Add to that some Chichewa lessons, on call for work, multiple trips away from Blantyre on weekends and being invited to dinner by a constant stream of friends given you’re the new kid on the block to begin with, and you have barely got time to scratch yourself.

We had also planned life in Africa to be somewhat of a break from alcohol. Think again. Greens, the local name for the ubiquitous Carlsberg beer (Blantyre being the only city on the continent with a Carlsberg brewery) due to the green label, seem to be a part of every activity here. Unfortunately, drink driving is also something that seems rather prevalent given the lack of safety on the streets at night and a complete lack of any formal taxi service. This isn’t helped by the police only owning a single breathalyzer for the whole city, and knocking off from work at midnight anyway. One of our friends, Henry, managed to get pulled over and tested by this one breathalyzer after a few too many Greens at the Blue Elephant one night.
‘Blow into the machine sir.’ Henry promptly did as he was told, although very softly.
‘No sir, like this,’ added the cop, demonstrating an adequate breath.
‘Oh,’ replied Henry, promptly sticking the tube up his nose and blowing as hard as he could. The policeman was apparently quite thrown by the yellow-green slime that now coated his brand new machine. Bewildered, he examined it for a moment.
‘You can go sir,’ came his less than confident response to this somewhat unconventional method. ‘What’s my reading?’ inquired Henry, now rather amused by the whole thing.
‘Um, I don’t know, but you can go.’

'To drink and not drive,' quotes Henry, 'now that would be dangerous.'

July 24 - Furniture time

July 24-August 2
You don’t just turn up to a megastore here and get all your furniture needs in one go, this is Africa. Like the taste of their local beer, furniture is something you acquire slowly (admittedly Chibuku is something we could never, no matter how long we stay here, get used to – something akin to drinking overdue milk with a generous lashing of sand stirred through).

How to buy a bed. Head down to the local eatery and befriend Kusum, the lovely Indian woman who owns the place. Temptations Coffee Shop, although sounding rather cosmopolitan in name, is actually little more than a few plastic chairs sprinkled haphazardly around some dilapidated linoleum covered tables, a solitary pie warmer atop the counter that barely keeps alive a few very dead looking samosas and a sausage roll or two, and a dusty little food preparation area where the ‘chefs’ churn out the daily special as written in marker pen on an old piece of paper, obviously not having differed for several months. ‘Chambo, nsima & vegetables, 250MK.’ As you eat, you listen to the choke of traffic from a busy intersection outside. Temptations, indeed. At least the food isn’t too greasy. Oil is somewhat of a national obsession here, and when you hear that the roadside chips are fried in oil stolen from electricity transformers, it doesn’t make it too hard to forego. Kusum’s sister, Vibha, was downsizing her current bed, so within a day of moving into our house we were the proud owners of a monstrous king size bed with oak bed head and bedside tables, complete with garishly pink doona cover that is simply too kitsch to do away with. Perfect.

Next, a lounge suite. Straight down to the curio market in the centre of town to meet Joseph, an entrepreneurial young local who makes cane furniture relatively cheaply. Two armchairs, a sofa couch, a coffee table and a large mirror, all hand delivered… and I mean that. They literally hoist the things onto their heads and walk from the centre of town to wherever you live. It’s actually not too uncommon to see locals walking the streets with beds, couches, chairs and other assorted pieces balanced precariously on their heads. Our cushions we then had made from offcuts at the local foam factory before the local material shop did a nice job of covering them, side piping and all.

A dining table? This time off to the main Blantyre market for some protracted bargaining. A few hours later we had a heavy rectangular wooden dining table and six wonderfully garish old English style dining chairs complete with lurid red patterned seats and backs perched in the back of a pickup with half a dozen local boys holding them in place on the way to our house. What more could you want in the middle of Africa?

Kitchenware? Expats mostly. Second hand markets, house sales, friends of friends, notice boards at supermarkets. A slow trickle of goodies are slowly finding their way to our kitchen, gradually allowing us to feel like we can begin to cook as we want to.

For some items we reluctantly hit the more conven- tional stores, not wanting to get stuck with a malfunc- tioning fridge or stove. Game, the new South African homewares superstore (Bunnings meets Harvey Norman… although I think that’s overplaying it a little), seems to be the cheapest and best for reliable goods – that is, once you’ve organised ludicrous amounts of cash to buy anything (you can only take out 20,000 kwacha per day from ATMs, all in the largest denomination of 500MK notes, which means several trips to the ATM for one fridge purchase), cut the wiring, stripped it back and changed the plugs of the South African appliances to the Malawian UK variety, and had the wrong fridge sent over and therefore sent back again. Even then, the door decides it wants to pop open relatively regularly meaning your food goes off just that little bit quicker. Looking on the bright side, I guess it saves on defrosting.

July 21 - Next comes a house

Houses and house ‘boys’

July 21
All the modern houses here seem to follow the same recipe. Monstrous high brick fence adorned with fashionable barbed or electric wiring, expansive luxuriant gardens that dwarf the still rather sizeable but more than a little rundown house. You have a guard – just honk at the gate and it shall open – who works by night, sleeping most of the time you’re not looking (but who can blame them). You also have a gardener, and of course, a ‘house boy’. The latter is a cook, cleaner and general jack of all trades, not, as the name may suggest, a young Thai fellow. These local employees, invariably desperate for the work they have, are paid a paltry salary in western terms and seem to work hours completely foreign to you and I. This understandably creates problems for many given the obvious disparity of wealth between employer and employee, with stories of theft, absconding, unpaid loans and other requests for money rife throughout the expat scene, and it didn’t take us long to be regaled with everyone’s opinions and experiences of staff they have had, currently have or had heard of.
‘How do we find staff?’ we had naively asked Tom, one of the other paediatricians, at dinner.
‘Oh don’t worry, they will find you.’

Advice from all and sundry regarding houses and house boys abounded in those first few weeks.
‘Make sure you get references from your staff.’
‘Pay them well and they won’t ask you for money.’
‘Loaning them money is a problem.’
‘Don’t overpay them.’
‘Have a written contract.’
‘Get a house with security doors.’
‘Make sure you don’t have vacant land beside your house.’
‘The College of Medicine will help you find a place.’
‘You’ll need to pay 3 months rent in advance.’
‘Electricity is a problem, as is water, so choose your location carefully.’
‘You could look on notice boards.’
‘Use an estate agent.’
‘Surely there’s an expat leaving, you can take their house.’
‘You don’t want to use a real estate agent.’
‘Check the roof.’
‘Check the security.’
‘Check the nearest Rapid Response location.’
‘Quiet streets are bad.’
‘Busy streets are bad.’
You name it, within the first couple of weeks of arriving in Blantyre and looking for a house, we had heard it all.

Heth did most of the house hunting, with my work taking up the majority of weekday working hours. She looked at six or seven places over the week, ranging from College of Medicine flea ridden dumps to grand four bedroom behemoths that were far too big to consider furnishing for only twelve months. After I looked at a couple of prospective choices it was abundantly clear that the one we ended up taking, a small two bedroom place in the suburb of Namiwawa only three minutes drive west of town, was the right choice. Our place is termed a town house, although it is simply a series of five similar almost free standing houses that share the same compound and gate, with the added bonus that you don’t have to organise hiring a guard (although that was to turn out to be somewhat of a saga in itself).

Our garden stretches back almost twenty five metres – a small one by Blantyre standards – and is adorned with a swathe of lovely papaya, avocado and mango trees, frangipani, bougainvillea and other tropical delights, as well as a ready-made vegetable garden. Our konde (the Afrikaans word for ‘balcony’, which everyone seems to use here) is a small elevated brick square construct draped in creeping vines and hanging potted plants. It looks out over Mount Muchiru, one of the three beautiful peaks which encircle suburban Blantyre, completing the perfect scene for a lazy late afternoon ‘Green’ with the sun blazing it’s reds and pinks through the dry season dusts… at least until the mosquitoes descend upon you in force each evening.

We have a small dining area with attached bar and an open walk through to the living area. There’s a small kitchen – most kitchens are small and closed off here given the majority of house owners employ a cook and don’t have any need to spend much time there – and two sizeable bedrooms with one small, slightly run down bathroom. Comparatively speaking, our house, although smaller than many around here, is relatively well maintained and quite new, something you particularly notice in the kitchen and bathroom in many places. Despite this, the one bullet that we weren’t able to dodge was the lack of anything in the house whatsoever. No stove; no curtains; no phone lines; no lamp shades; nothing. It seems standard here that when you rent a house you have to fit the entire place out. Not really what we were expecting only being here for a short time, but as they say: ‘When in Rome…’

Either way, we have been here only a week and a half and now have ourselves a comfy little home that we are gradually turning into something our own.

July 18 - Time for a car

High Clearance is Essential

July 18
Our plans for the year in terms of transport?

Minibuses are everywhere, and although they’re not the most reliable, we figured between these and walking we would cope. Maybe a bicycle or two to help out for longer distances. Either way, not having a car would not be a big issue. Perhaps we were a little scarred from having sold our last car in a pub on the side of the highway for $200 after it blew up earlier this year in rural Australia.

‘Now, you’ll need to buy a car,’ Liz finished with, after our tour of the hospital only one day in the country.
As if we weren’t shocked enough with the hospital we would be working in for the coming year, we were now told we would be spending somewhere around four thousand pounds (yes, the British variety) on a car – not what we had planned with the money we had brought over. However, we very quickly learnt that almost every expat has a vehicle here given how difficult, and often unsafe, it is to move around at night. Added to this, my on-call responsibilities mean that I have to be mobile any time, and QE isn’t exactly a stone’s throw from the city centre.

We quickly learnt that a four wheel drive, or at least a high clearance vehicle, is something of a necessity. Not so much for the driving outside town, but more for the cavernous potholes in Blantyre and its surrounds. That and avoiding an automatic, given the complete lack of any parts for servicing the car should you run into transmission problems. Oh, and make sure you have a mechanic check the car out before you buy it. Two days in we had bought one. By the following Wednesday, less than a week in the country, we were driving around in our new low clearance two wheel drive automatic with nothing more than an assurance from the guy who sold it to us that it was a good car.

In saying that, the 'Silver Stallion', our rather sporty little Toyoto Marino, seems to get us everywhere. It was about half the price of a high clearance vehicle, guaranteed by the head of one of Malawi’s biggest NGOs for free repairs for any problems within three months, is very petrol economical (a rather expensive commodity here) and has only seen seventy thousand kilometers. Plus, any weekends that we’re heading out on terrible roads we can always borrow a 4WD from friends. Well, at least these were the thoughts we assuaged ourselves with as we scraped our way across Blantyre’s obscenely high speed bumps the day after we bought it!

Buying the car was, of course, the easy part – the real headache comes with registering it. Zoological, chaotic, disorganised, dysfunctional, inept, illogical. All words that were clearly designed to describe the otherwise indescribable mess that is the Malawian Road Traffic Authority in Blantyre. ‘Pack a picnic lunch,’ was the general advice on registering your car here… couldn’t have hit the nail on the head better. Let’s just say we’re not exactly looking forward to organising our annual Certificate of Fitness (car roadworthy) in January.

July 13 - The Hospital

Q.E.

July 13

The World Health Organisation lists 177 countries from first to last in order of quality of life as assessed by life expectancy, literacy, education and standard of living. This Human Development Index places Malawi in position number 164, making it the thirteenth worst country in the world to live in from a health perspective. The bottom 24 countries in this list are all African nations. Not a single mainland African country sits within the top 50.

Queen Elizabeth Central Hospital, or ‘Q.E.’ as it is known locally, is something to behold. An overcrowded, under-resourced sprawl of dilapidated single-storey buildings that grab you by the shirtfront and smack you straight between the eyes the minute you walk into the wards. Q.E. is like nothing Heth or I had ever seen before, let alone considered working in.

Liz, the Head of Paediatrics, picked us up on the Friday morning for a tour around the hospital, less than twenty four hours after being in the country. I wasn’t starting work until the next Monday, but this was a good opportunity to have a look at the conditions we would be working in for the coming year or more. Several weeks in I am so accustomed to everything at Q.E. that it hardly seems abnormal, yet that first stroll around the wards was one of the most truly memorable experiences we have had since arriving here, and that is not meant in a complimentary way.

The smell hits you first. Africa. It smells of Africa. Everything about the continent is condensed, boiled down into one all consuming, all powerful smell that literally knocks the breath out of you the first time you walk into the hospital. Body odour, unwashed clothes, dirtied nappies, flies and food scraps, and of course the unmistakable scent of death. Q.E. is like nothing I have ever smelled before. Within a day you are used to it, but for those first few minutes the smell is almost nauseating… not so much for the smell itself, but perhaps for what it represents, and the fact that I would be responsible for the multitudes of tiny lives with thin dark bodies and boggly white eyes in front of me in three days time.

The general conditions on the wards are what grab your attention next. Small African children littering countless numbers of square boxed cots, packed in two or three to a bed, their mothers or guardians (many don’t have mothers, such is the devastation of HIV/AIDS in this country) sitting forlornly at their side awaiting what feels like a palatable inevitability. The neonatal ‘Chatinkha Nursery’ is a chaotic jumble of makeshift wooden ‘hot boxes’ where newborns lie in their own excretions and wait helplessly to receive what little treatment there is available to them – mostly antibiotics, oxygen and anti-seizure drugs – and the temperature of the entire room stifles any sense of wellness, kept high rather than heating each individual crib, as that would require unobtainable resources.

Then comes Moyo House, the nutritional rehabilitation unit, the word itself meaning ‘health’ in Chichewa, the national language alongside English. This place doesn’t even draw vague parallels to the western world of medicine. It is a large barn-style room – exactly what you don’t want for keeping the warmth up to these desperately sick kids – lined with bed after bed of gaunt little skeletons of children who all gaze at you with the piercing stare that usually adorns the faces of television commercials pleading for aid from far away countries like Ethiopia or Sudan… or Malawi. Moyo House is the ward that most makes you feel as though you’ve stepped into a different world, a world where everything you take for granted is pushed aside, and the cold reality of desperate poverty is shoved straight in your face.

Passing through the Paediatric Nursery, for kids under 6 months, and the Medical Bay, for the ‘stable’ patients, comes the piece de resistance, the Paediatric Special Care Ward. For me this was initially the most confronting of the wards, with well over one hundred children squashed into two completely inadequate bays, their families sprawled in a mayhem that permeates every inch of floor space. This place redefines chaos, a chaos that should never have to be associated with a hospital… yet it’s simply the norm here. One or two nurses are completely engulfed by the commotion in this place, and there is little doubting that staffing is a major issue. They also have an isolation room here, for such diseases as rabies or cholera or measles… the ‘really’ infectious kids.
‘… and tuberculosis?’ I inquired, ignorantly.
‘Far too many to isolate them,’ countered Liz matter-of-factly, ‘they’re all in together.’

One week in and it all seems normal. The smell; the crowding; the lack of resources & nursing staff; the near nonchalance with which one meets disease in volumes simply unthinkable in the developed world. Strange, isn’t it, that a scene like this could ever even be contemplated as one which you simply accept as how you now practice medicine.

July 13 - Settling In

July 12-23

The College of Medicine guest house was our home away from home for the interim. Our room consisted of a double bed with mosquito net, small desk and chair, and an en-suite bathroom with shower. Not bad by African standards, but after four months on the road travelling through Russia and Eastern Europe for our honeymoon we were craving our own personal space - space that this guest house was very much lacking. On top of this the positively deserted feel to the place made for some lonely nights. Kingsley, the cook, who looked like nothing could raise him from his seemingly permanent semi-comatose state, would prepare a meal for us some time around 6pm – invariably chicken and chips, chicken and rice, chambo (local fish) and chips or chambo and rice – then leave us to run the place. A few others came and went, but more often than not we would be the only ones in the place. Added to this, the almost daily blackouts that lasted several hours made this place seem almost haunted. The electricity cuts were at least predictable. One evening, the following morning, then thirty six hours on before it stopped again. It is so predictable that the local newspapers have sections dedicated to advertising the power cut times.

Unfortunately the guest house was somewhat of a prison for us given the difficulty in going out at night here without your own transport. It isn’t safe to wander the streets at night – in complete contrast to the daytime – and there’s no public transport after 7pm. And taxis? Not a chance. I think this would have to be one of the only cities I have been to where taxis simply don’t exist. You can organise private drivers to act as taxis, although the comparatively extortionate prices make this somewhat unattractive. I guess the locals just can’t afford taxis, and anyone who can owns their own car anyway, so there isn’t a market for them.

Our first weekend was one of discovery, having the time to enjoy before starting work on the Monday… and it’s funny how quickly things begin to feel normal. Our first walk into town, however, felt anything but normal. In a place devoid of white faces for the most part you are acutely aware of how black everyone is, or perhaps more correctly, how white you are. It is a feeling that rapidly disappears into a warped normality, however the initial feeling is quite confronting. Yes, everyone is exceedingly friendly and always ready with a 'hello' and a smile, but you sill feel a little like a fish out of water to begin with. The fume belching minibuses that hurtle to and fro with little regard for pedestrians, dusty roadsides choked with the many too impoverished not to walk, makeshift telephone centres with cords strung haphazardly to their plastic table and chairs, banana and strawberry vendors competing with orphaned children begging for your attention and money. Everything here was new to us, not because we haven’t seen any of it before, but more because this is our new home. Perhaps the best analogy would be that of scuba diving after having not done it for a while. Initially the underwater breathing and general environment is almost claustrophobic, heightening your senses to a startling level and allowing every little aspect of your new world to catch your attention in a detail that seems almost surreal and exaggerated. Yet as you ease into your new surrounds the previously foreign stimuli become less so, and before long seem like nothing more than regular features of life. And so it was that after a few days of wandering the chaotic streets of central Blantyre, working out the minibus system, discovering the frenetic market and roadside stalls and finding ourselves a few little eateries, we became used to our new home… Malawi.

In saying that, how accus- tomed you rapidly become is a very relative thing. Malawi continues to amaze you with her unbelievable intricacies, and the longer you spend here the more you get to know them. The roads are perhaps the most striking examples of these. Boys hold out startled dogs and cats on the roadside, displaying them like fresh market produce being hawked to drivers-by. Cars meander around the roads, their drivers in their own world, completely unaware of those around them and obviously in no particular hurry. Giving way is something for the meek, and traffic lights are more a suggestion that a rule – in fact, some traffic lights are simply switched off after dark, allowing the cars free range of otherwise unsigned intersections. Not that the police could do much if you are caught doing anything wrong; most of them don’t have cars or guns, and radios are simply non-existent. Potholes are a fact of life, and many roads even in town are in a state of disrepair that is laughable. Black clouds of pollution emanate from minibuses with such tenacity that it’s often hard to see the vehicle in front. Then there’s the pedestrians – once again a world unto their own. Driving here is like taking your car through a city mall: no one expects your car to be coming through and they’re certainly in no hurry to jump out of the way. All too commonly pedestrians will wander out into the middle of a main road and be genuinely surprised to see a car bearing down on them… that is if they even bother to look at all. They use the road as a footpath, change direction or cross roads with little to no warning, and are completely unaware of what the traffic around them is currently doing. Needless to say, traffic simply has to slow down or risk killing someone every minute or so. Then there's the food, with Africa’s disturbing love affair with fried chicken and chips – although not quite as bad as somewhere like Kenya, where an entire meal can consist solely of a plate of deeply fried chipsi – and the maize-based staple, nsima, the thick gelatinous and bland polenta-like carbohydrate that adorns most plates and is eaten with the hand in vast quantities. But that’s just life here… you get used to it.

July 12 - Introduction

July 12, 2007

Shit!

I don’t think it matters how long you have spent in the squalid and unfamiliar surrounds of the developing world, indeed sub-Saharan Africa itself, nothing quite prepares you for the shock of realizing that you are entering this environment that is to be your life, your existence, from that point on. The surreal bubble that a backpacker or a transient traveller exists within when they move through regions like this is so far from the reality that smacks you straight between the eyes the minute you step off the plane with the daunting new moniker of expatriate. Even the word conjures up fear when you look too closely at it… you were once a patriot, now you are now no longer.

Blantyre’s Chileka airport, somewhat dubiously granted the title of an international airfield, does little to assuage any initial trepidation. Walking across the tarmac to the handwritten ‘customs’ sign you are greeted by a chalkboard painted with a welcome note, below which you are told that the paint for the welcome note has been ‘donated by Blantyre Central Paint Supplies.’ Passport formalities are anything but, with the casually dressed African standing behind a rather hastily constructed wooden lectern ready to stamp just about anyone’s documents before moving you back to the tarmac, where you watch your bags being unceremoniously dumped atop the pile of already unloaded luggage, ready for you to pick through at your leisure.

Being driven out from the airport along the eleven kilometre road into town in a clapped out shell of a 4WD that is the University of Blantyre, College of Medicine vehicle, only reinforces the ruminations… “What the hell have we done? It seemed like a good decision at the time!” Potholes merge into the edge of the tarmac which drops abruptly into the red dirt of the roadside. People swarm along the roads, paying little attention to the cars that rattle past, nor insight into the damage one would receive should their seemingly mindless wanderings put them in front of one. They carry their lives on their sturdy heads, caring most about selling a handful of bananas or a telephone call from their makeshift roadside telephone to pay for another meal that will hopefully keep their child away from the specters of malnutrition. Relatively few cars ply the roads given the average Malawian is pressed to be able to afford enough maize for their daily nsima, let alone considering purchasing a vehicle. The wealth this would require is incomprehensible for them, thus the ‘rich white man’ syndrome is positively alive and kicking here. These are all immediately clear observations one makes, despite only having been in the country a few minutes.

Blantyre’s city centre continues the theme of failing to inspire confidence on first impressions. Ramshackle collections of dilapidated buildings that lurch one-into-the-next paint a rather untended palette, paint peeling and crumbling walls complementing the overall appearance. Banks dominate the more modern looking constructions, yet even these sit at a maximum of two or three stories and yearn for a bygone era. Cars, pedestrians, pollution and vendors jostle for position in the chaos that is the centre of this eight hundred thousand strong city… and maybe the word ‘city’ is being a little generous. Either way, this truly African swathe of existence is what we are now living in. Our home. Like it or not.