Jul 13 - The End of the Beginning

July 13

With our first entry exactly one year and one day earlier, we now prepare to depart this amazing country, our lives completely changed by what we have done, seen and given in Malawi.

After an amazing string of going away parties, dinners, showers of gifts of appreciation, speeches, songs and cakes and photos and so many brilliant friends, it all culminates in the mixed feelings of leaving this stunning country, yet happy to head home and see family and friends.

The work we have done here has given us both immeasurable experience and opened our eyes to a world that cannot be realistically imagined for those who have not been here and seen with their own eyes. One of desperate and unrelenting poverty, of a devastating lack of education, medicines and basic sanitation, of death and disease so common that one is simply numbed by its omnipotence. Yet a warmth and welcoming from the people that is second to none, of smiles that melt your heart on a daily basis, of a country that earns its moniker ‘the Warm Heart of Africa’ with consummate ease. Despite every frustration, and believe me there’s certainly no shortage of them around here, there is nothing we would change from our time here. And we have had the opportunity to meet so many interesting people from so many different walks of life, both Malawian and mzungu, who will all now drift their different ways as we do ours.

With all the various prints, souvenirs and photos that follow us home, none will compare to the memories of the lives we now have here and that very, very accurate expression about this vast continent: ‘Africa, it gets into your blood.’ Let’s just say that this is simply the end of the beginning.

Jul 12 - I Will Never Forget

July 12

It is hard when you live in a country such as Malawi, possibly the poorest non-worn torn in the world, to not been somewhat jaded by the constant asking for money or other handouts from locals here. It is not altogether surprising, with them constantly seeing our relatively ridiculous wealth, but it remains difficult to deal with on a day to day basis nonetheless.

Yet with the time having come for us to organise moving – our sixth time in the last seven years, so something we are becoming somewhat proficient at – we were exposed to a very different level of appreciation with some of our parting gifts to Malawians. We gave Evance, our very trusty staff (something which many people here have interminable difficulties with in Blantyre), many of our belongings that we felt we wouldn’t need to take home with us. Many old clothes, chitenge material, bundles of small coins and various other odds and ends. His response to our parting gift was an overwhelming smile from a very grateful man. ‘Thank you. You are definitely looking after my wife and my family, thank you, thank you.’ He certainly likes saying ‘thank you.’

We gave our local banana boy – the kid who sells us bananas by lingering around outside our local shop – 200 kwacha yesterday. He offered us some bananas, but I refused, telling him that this was simply a tip for being such an honest and friendly kid, never even thinking to try and rip us off. His English isn’t that good (and our Chichewa is embarrassingly poor outside a hospital), but his friendly smile that we’ve come to know so well beamed broadly across his young face, ecstatic in the knowledge that our simple little offering (less than A$2) would be the equivalent of ten or twenty banana bunch sales.

Charles, our night guard on our property, who we share with the other residents in the adjoining houses, is amazing. You can’t blame these guys for sleeping through the hours of the early morning, when most of Blantyre lies in slumber and very few people come and go, but every time you arrive home, whatever the time of night, Charles is always quick to heave open our stupidly heavy iron gate and greet you with a friendly zikomo, ‘thank you.’ Through the year we have sometimes brought him left over food and asked him to leave the container outside our door in the morning. His parting gift from us was a sleeping bag to help shield him from the cold of the winter months in his tiny little concrete guard’s room beside the gate.
‘Zikomo kwambiri. Thank you very much.’ He beamed irresistibly. ‘I shall give you back the container, yes.’
‘No Charles,’replied Heth, ‘that’s the cover, you put the sleeping bag back in it each time you have finished using it. You should keep that container.’

Finally Peter, the staff boy who lives on our property. He is employed by the owner of the complex, our next door neighbour, and mostly works for her. Yet without us ever asking, he is always out there taking out our rubbish or cleaning our car if Evance isn’t around. He fixes cracks in roofing tiles, sweeps around our front door and whizzes around looking after so many little communal areas without complaint, and he’s always the first with a ‘good morning Sir, good morning Madam’ the moment we leave the house each day. His gift was a collection of clothes to add to the meagre 2 pairs of pants he currently owns, as well as a sleeping bag to help keep him warm at night in his small staff house.
‘Thank you madam, thank you,’ he bowed gratefully, ‘I will never forget.’ A huge smile split his face in half for the rest of the morning.

Jul 5 - 'Haves' & 'Have Nots'

July 5

You would not be altogether wrong for thinking that on first glance this country is completely devoid of any middle class. And even after living here for a year, it becomes plainly obvious that this small but growing proportion of the population is not readily seen. I have read somewhere that Malawi has the second greatest wealth disparity in the world. I’m not sure I completely believe this statistic, but what is starkly evident is that there is an unfathomable rift, which remains ever widening, in the wealth of this country. And never before has it been so evident to us than tonight at a going away party we attended for a couple of our friends.

The house it was being hosted at was a Malawian British-Indian’s who currently works as the Standing Consulate General to the British Embassy. A man who owns many businesses around town, and who’s two sons use it to entertain on a scale more lavish than anything I have ever seen. A house so large it has separate entertaining and living wings, an enormous mirrored jacuzzi and full size billiard table and a bar that wouldn’t be out of place in a night club. The gardens look like the set from a Jurassic Park movie by night, the vast expanses of manicured tress and garden beds stretching out into the floodlit darkness further than the eye can see. Staff waited on us with all manner of food being cooked up on the four level barbecue with the full bar keeping the thirstier going, and the dance floor with permanent mirror ball and smoke machine pumped out tunes. It was a completely surreal experience to be in a country like Malawi, with unimaginable poverty living literally on the other side of the gargantuan walls of this residence, to be having a party in luxury the likes of which even wealthy Australia would have trouble competing with.

Interestingly, driving home passed the ex-president, Muluzi’s house, apparently even bigger than the one we had just come from, we thought about it all. In Australia if we saw a property or wealth such as that we wouldn’t immediately feel that they were taking from others around them many so sorely needed dollars, but here its simply different. It is difficult not to think that these people, simply making a life by running their successful businesses in town (a little different to the politicians… but that’s a whole new kettle of fish), are somehow cheating this country, taking more than their share. Either way, Malawi is littered with the ‘Haves’ and the ‘Have Nots,’ and never before have they seemed so apparent.

Jul 4 - A Full Circle

July 4

The stodgy white that was being served out from the large cooking pot wasn’t exactly inspiring. We had been here long enough now to know the right consistency of the Malawian national dish. Evance, our house boy, said he knew how to make nsima, but with our ten or more guests already sitting on our khonde, we were beginning to doubt it somewhat – and they were Malawian, they would know the difference. Nsima, beans and masamba (pumpkin leaf in ground peanut flour) for the Malawian touch, then some roast chicken and potatoes along with salad for the Western touch. At least we had an excuse: Mzungus attempting to cook Malawian food.

Heather’s palliative care departmental team lunch went well, with the Malawians mostly sitting there quietly smothering their food, salad included, in layers of salt, while they devoured their soft drinks with an almost religious fervor. The few mzungus tried to keep conversation flowing, but that’s just the way it often is. We ended with a present giving ceremony of sorts, the Malawians dropping to their knees to hand us our gifts for Heather’s unpaid help the whole year. A beautiful African wall hanging, a large chitenge and a far from beautiful Malawi carved statue letter holder. And for “mister,” a touristy black Malawian t-shirt. All very thoughtful indeed, and Heth even managed to almost hold back tears while she spoke… how very brave she is.

It was after lunch, with everything cleaned up and myself having gone back to work with the car, that Heth noticed. Walking towards Queens rather than taking the minibus, Heth was struck more than usual by the cacophony of action on the streets, the overwhelming lack of white faces, the friendly 'hellos' with beaming smiles. It wasn’t lost on her that these were the feelings identical to the last time we were without a car, back when we lived in the wholly uninspiring College of Medicine guest house with the grumpy cook, Kingsley. Before we had slotted comfortably into the Blantyre social scene and knew the ins and outs of living in an African city. Back when Heth was without a job and would walk the streets battling with lethargic Malawians organising our brand new expat life while I accustomed myself with the workings of a completely foreign hospital setting. It wasn’t lost on her that our life, in this last year, had indeed turned a full circle. This weekend we would lose our ultra-comfortable bed to the new owner, next week the car, and next weekend the house. Soon after that we will be making our way independently to Lilongwe, bags in hand being the only possessions we have in the country, on our way to the airport. And with all these feelings, whether or not by nature of what we had mentally prepared ourselves for next, she thought to herself, its time to leave.

Jun 22 - Car Trouble

June 22

Swiping a cow on our way up from Blantyre after innumerable difficulties with our car servicing the day before was enough fun with cars for one weekend. As we took off from Dedza, an hour south of Lilongwe, to pick Cat and Sandy up from Kamuzu Airport, the previous day’s antics were well and truly forgotten. That is, until 30 minutes into the drive at a little over 100km/h when an unholy explosion threw the car sideways on the road, pieces of shredded tyre flying everywhere like confetti. Despite the tread of our front right tyre having just self combusted, the inner rubber of the tyre proper somehow managed to hold itself together whilst we rolled safely to a stop.

We were then descended upon by a cacophony of intrigued but friendly locals from a nearby collection of grass-thatched mud huts who were very quick to lend a helping hand. Kids scattered tree braches up the road to warn oncoming motorists, older boys spun the jack handle furiously to lift the car, and the young adults took the wheel to help change over to the spare. Within 15 minutes, even accounting for the jack not actually being big enough to lift the car off the ground, we were on our way once again, minus a few pieces of plastic guarding around the wheel that had been obliterated by the shredded rubber.

It’s always funny listening to the innumerable car troubles that people seem to run into here in Malawi. Whether it’s the crappy condition of many road surfaces, the ageing population of second hand cars going around, or the plethora of extra obstacles to avoid whilst driving, you seem to hear of many more car trouble stories than back in Australia. Seven punctures in one day on a trip to Zambia, hitting a pedestrian at night, being arrested by Interpol for driving a stolen vehicle, totaling the back of a car thanks to a tree in a game park, a wheel falling off a moving high speed vehicle, driving off the side of a narrow bridge, shattering the suspension four wheel driving, countless stories of overheating, abandoning cars in the middle of nowhere that simply pack it in. You name it… all very true first hand stories from our expat friends in Malawi, and that’s before you even begin on the minibus mayhem.

But there’s one string of bad luck from an English mate of ours which simply takes the cake. Arriving not long after we got to Blantyre and finding an absolute steal of a price on a Toyota Serf, Chris was warned by all and sundry that maybe his ‘too good to be true’ price was, well, too good to be true. Needless to say, one week after taking it on, having had a reputable mechanic tell him that it all looked fine, he was back at the same mechanic now being told that it was riddled with problems. Multiple thousand kwacha and several weeks later, the red beast was back on the road. One week later, however, the mechanic was reading out another sorry diagnostic array. A complete engine overhaul this time, many more weeks and several hundred thousand kwacha.

Two months later, after several increasingly irritable phone calls, Chris finally hears from the mechanic that he hasn’t even picked the car up from his garage, let along started working on it. A few more heated exchanges and the mechanic decides that Chris is a ‘bad customer’ and tells him where to go (so much for ‘the customer is always right’ policy). Several more months later and another mechanic finally picks up the car, only to hit him with the news that several parts need to be purchased because the previous guy has stolen several of them. Finally, with everything ready to go with the repairs, only nine or ten months later, Chris has managed to lose half the parts he struggled for so long to find. Too good to be true? Maybe.

Jun 21 - Cow Collecting

June 21

Trying to screech to a halt from almost 100km/h is no easy feat, especially in the dark of night with a cow having suddenly wandered onto the road. Needless to say, when we managed to thud into the impressively large beast, its head cracking into the windscreen with a rather disturbing ‘cow’s head hitting a windscreen’-like sound, it just capped off what can only be described as a bad day.

12 hours earlier we had awoken to a sunny Saturday, the start of holidays. With Cat and Sandy arriving the following day in Lilongwe, we thought we could quickly get our car serviced that morning, then whip up to the small village of Dedza, an hour from the capital, for an afternoon of reading books, relaxing, and enjoying being out of town.

The first hitch to the day came when the mechanic, a highly recommended guy who services vehicles for big businesses around town, turned up an hour and a half late. Added to this, a part I had bought was apparently not to his liking, so he had to then head back into town and get the right one, further delaying things. Four hours later, having sat around the house waiting impatiently, they told us the 3-4 hour service would only be an hour more. Two hours later it was only 20 minutes more, then an hour and a half after that we finally had our car ready to roll. Got to love Malawi.

Being able to finally laugh that one off we jumped in the car to head off, ready for our holiday to begin. You can then imagine how calmly I reacted when our previously perfect vehicle began spluttering and stalling after driving for less than five minutes. Another hour later, our mechanic having met us at a service station and rather swiftly fixed the problem, we drove out of Blantyre a few minutes before 4.30pm (okay… so it had been my fault buying crappy spark plugs).

The problems with driving in the dark in Malawi are so innumerable that it makes planning your day rather carefully around not driving in the dark in Malawi a very worthwhile undertaking. Given yesterday was the winter solstice and hence the shortest day of the year, we would not have that luxury this time. At dusk every man and his dog (or 'every villager and his sack of maize flour,' as they say here) are frantically scurrying along the road trying to get home before darkness falls, with no sense of danger from the cars hurtling by them. Many of the cars, buses and trucks only sport one headlight, and for some even that is too much, which makes detecting them extremely difficult given the complete absence of any street lighting. Not to mention that several drivers have just finished off their afternoon Greens or Chibuku, with absolutely no notion that drink driving may be somewhat dangerous. Add to this a random pothole or two, almost invisible police road blocks and stray dogs, goats and cows and you have yourself one hell of a difficult drive.

So when the aforementioned bovine wandered into our headlights from the abyss of darkness, despite a good swerve and a few metres of tyre being painted onto the road, we still managed to collect a good portion of his head with our windscreen whilst traveling at the best part of 30-40km/h. Luckily, other than one hell of a headache for the cow, and a bloody fast heartbeat for Heth, everyone went their separate ways unharmed.

“What the hell was he thinking!” was Heth’s immediate reaction, a little shaken.
“Heth,” I laughed, “he’s a cow.”

Jun 14 - Ole Ole Ole!

Egyptians in Blantyre

June 14

Just when you think you've seen everything this country has to offer, you end up somewhere like a football match. And not just any match either. Malawi versus Egypt, the current Africa Cup title holders, in a World Cup qualifier. By all accounts it was to be a whitewash - the Malawi Flames being no match for the professional outfit of the Pharoahs, even if it was on our home turf. But that didn't stop thousands upon thousands of energetic locals finding their way into Kamuzu Stadium for a day of singing and tension to spur the local team on.

A 0-0 draw would have been nice given how much Malawi had thrown at the Egyptians without any reward, saving some face against the strongest of their group before the return leg in Cairo. After all, Malawi had disposed of the struggling Djibouti 8-1 two weeks earlier at the same ground, then held themselves to a respectable 1-0 defeat in the Democratic Republic of the Congo. Then, three and a half minutes into stoppage time, several spectators already pouring out to beat the rush, with the ref 30 seconds from blowing his whistle for the final time, the red, black and green slotted through an incredible goal, and the crowds went completely insane. Malawi had just knocked off the single strongest football nation on the continent, and the eruption in the shoulder to shoulder stands was nothing short of apocalyptic in celebration. The rhythmic dancing and jumping, indescribable to watch, looked as though it would collapse all four stands simultanouesly, and no doubt the roar could be heard kilometres from the ground. If there's one thing these guys no how to do, it's party when things are good. And right that second, they weren't getting any better.

I've seen hysteria at football grounds, whether an Australia-Uruguay qualifyier several years ago which we took 1-0, or an Aussie Rules match when 90,000 strong lift the roof of the stadium at the start of a game, but nothing quite comes close to the frenetic, almost-surreal chantings of a stadium full of Africans. This was most definitely one to remember for a very long time to come.

MA-LA-WI! MA-LA-WI! MA-LA-WI! OLE... OLE, OLE, OLE... OLE... OLE!

Jun 9 - Ele's on the Loose

June 9

These beasts are bloody big, right? If you haven’t seen a wild African elephant up close, with over 6-tonne of pure muscle staring at the insignificant little human figure in front of it, you may not quite understand just how threatening these animals really can be. Given a single move that a well grown adult considers not to its liking, he’ll flip even the sturdiest of vehicles without so much as raising a sweat. So as you can well imagine, physically relocating several of these behemoths from one Malawian game reserve to another, over 100km away, is not exactly a stroll in the park. The locals here aren’t the best at anything to do with organisation, so getting the South Africans in for this job was probably not the worst idea in the world.

Helicopter spotters complete with stun-dart armed rangers, massive craning equipment and elephant sized trucks; there was nothing small about this operation. Apparently all went well over the several weeks of work, with all the required elephants being bundled up successfully from Liwonde and delivered completely unharmed to Majete... hats off to all concerned. The problem, and of course there a problem, lay not in the transporting, but in the fencing. When 6-tonne of pure muscle gets a little disoriented in new surrounds, added to this a pinch of homesickness creeping in, a few flimsy fences ‘aint going to stop it. So as it turns out two of the bigger of the group decided on a little field trip through Southern Malawi… and this isn’t exactly a lightly populated region of the country.

If I was a local Malawian, minding my own business grinding my maize for dinner or lazily slinging my kid over my back and wrapping my chitenge around them, and I was confronted with a large grey monster over one hundred times my weight coming crashing through the trees, I’d shit myself too. Unfortunately for one unsuspecting villager, their reaction to the visiting elephant wasn’t seen as favourable by the oversized intruder, and the poor villager was consequently squashed into nothingness. More distressing however, was the reaction of the authorities who had let this bewildered beast wander off. With the South Africans unable to bring all their fancy equipment to the area where the stray elephant had now wandered (only a few kilometers outside Blantyre), the organisers decided to take matters into their own hands. Dumbo, simply trying to make his way back to Liwonde, was subsequently shot.

Jun 7 - Africa the Country

June 7

‘That’s where Madonna gets her children from, right?’
That’s about the extent of people’s knowledge of this tiny little peaceful country in central southern African that we live, a land area only half the size of the state of Victoria just below the tourist Mecca of Tanzania with its infamous Serengeti. Most people can’t even tell you what continent Malawi lies in, let alone spell the country’s name. It therefore doesn’t come as a great shock when you hear stories such as mailed letters commonly being misdirected to Mali – completely the other side of the continent.

Walking up the Boma Path, one of the most beautiful and most trying routes up Mount Mulanje, with some of our close friends, we heard a story from Ange that typified the world’s knowledge of this little known Commonwealth country. An international NGO worker recently tried to send a package to some of her colleagues in Malawi from her home city in the United States. After two months the delivery hadn’t yet reached Blantyre (which admittedly, isn’t that unheard of here), so she approached the delivery room of the company to find out where the package was ,given the company sends everything via registered mail.
‘Oh, it’s right here on the desk,’ came the official’s reply, obviously nonplussed by this oversight. Disbelieving, she asked why it hadn’t been sent. The reply she got?
‘The postal office sent it back because the address is wrong. You have written Blanytre, Malawi. There’s no country printed on it. You forgot to write that Africa is the country.’

Even Madonna, despite her ‘bond’ with our country, has spent less time here than your average holidaying tourist whilst ‘officially’ acquiring her orphan… but that’s another separate story in its own right.

May 30 - Malaria Anyone?

May 30

Every now and then you meet travellers making their way through Africa who have been inexplicably advised not to take antimalarial medications by their all knowing Western doctors. Their response to your amazement at this decision is usually something along the lines of ‘I’ll just treat it if I get it.’

Okay, so at Queen’s we see the little local kids who die in their dozens every day without access to good medications or medical care, mosquito nets or repellents, right? And as a tourist you’re going to have ready access to medical care, and if not you’ll have some treatment on hand that you can take in the interim, true? Plus, how many travellers do you really hear of who actually get malaria, it’s mostly expats, isn’t it?

All reasonable points, but given the similar lack of immunity between the average African child and an adult tourist, the often remote nature of travellers and swiftness of malaria, along with the low proportion of travellers compared to people living here, none of these arguments really stack up. And once you’ve seen the clinical effectiveness and swiftness with which this little parasite can do its thing, you quickly realise that this reasoning is nothing short of madness… something that one of our good Australian friends here recently found out.

Despite being in the centre of the biggest city in the country, where all medical personnel are acutely aware of malaria and have ready access to very good treatments, he was hospitalised within hours of his first few fevers. Two days later, even with all the appropriate medicines in his system, they were talking about airlifts down to South Africa for more aggressive supportive care. Luckily for him, he remained in Malawi, and within a few days was even able to get home, but promptly flew back to Australia for follow up treatment of complications that had arisen. Not exactly what he bargained for only being here for a short stay and in a city the whole time, thus thinking that antimalarials would be a redundant idea. Think again, I guess.

May 3 - Mulanje Misguided

May 3

As much as we have formed somewhat of a love affair with the majestic Mount Mulanje, our favorite weekend getaway, it is not a place without its own problems.

This enormous massif was once home to vast numbers of an endemic tree called, rather unsurprisingly, Mulanje cedar. Unique in its ability of being not only a firm and consistent grain of wood, but also impervious to the destructive nature of termites, water and other little nasties, making it just about the best building material going around. Houses, furniture, boats, souvenirs, you name it, Mulanje cedar is perfect for it. So as you can imagine, the logging industry that is generated by such a sturdy timber is nothing short of diabolical for these trees. They are their own downfall, so to speak. It is completely commonplace to see barefoot Africans, muscles rippling, as they lug up to 70 kilogram planks of the stuff down the precipitous mountainside (it’s sold per kilogram at the bottom – a log this big fetching a rather appealing 700 kwacha for the transporter). Interestingly, it’s the Department of Forestry that polices the illegal logging, yet these guys are so inept and corrupt that not only do they completely ignore all illegal activity, but they’re actually the ones buying the bloody stuff to sell on to manufacturers to make a quick buck!

Last year the Department of Fisheries and the Department of Forestries made a deal to build 40 new large fishing boats from Mulanje cedar in order to bolster the resource use of Lake Malawi. Not only did this deal employ dozens of new loggers who simply disregarded their quotas and took down approximately ten times the amount licensed by the government, but the amount of legally cut wood that actually got to the dockyards allowed only 4 boats to be built in the 12 month period! And if that’s not enough of an insult to the environmentalists trying to preserve the cedar forests, the government is currently in the process of developing another extended contract between the two departments so they can get the full number of boats built. Fantastic, isn’t it?

Added to this, back in the 1940’s and 50’s, when the Brits were plundering their way through Africa and ‘benevolently’ converting everyone to Christianity, they decided that Mulanje would benefit from planting vast pine plantations. This was seen as fast growing wood that is reasonable for building, thereby alleviating the local reliance on cedar. What they forgot to factor in is that pine has a rather cancerous ability to take over everything, blocking out so much sunlight with its canopied spread, that it renders the soil infertile for other plants and trees to grow. So since the Brits took themselves back to their northern isle in the 60’s, everyone has been trying desperately to clear these pine forests before they completely destroy the rest of the ecology on the massif.

Just wait until the big businesses finally sink their rapacious claws in and the government finally acquiesces to mining the bauxite that sits under one third of the entire plateau… goodbye mountain!

Apr 24 - The Other Side of Blantyre

April 24 – by Heather

When people hear you work in palliative care in Malawi, they often comment on how depressing and sad it must be. True, I spend most of my day with patients who are incredibly sick, and may not see the next week or month. They will almost certainly not know any of their grandchildren. But this is not something unique to palliative care here. With an average life expectancy of 40 years, it will be uncommon for the current generation of young adults, 20% of whom are infected with HIV, to see more than the generation below them.

The concept of palliative care is reasonably new to Africa, and very new to Malawi. It has been only in the last three years or so that there has been any palliative care available at all to patients in this country. So really, it feels quite a privilege to be working in a clinic, where we prioritize a holistic approach, and spend time to talk to patients, and learn about more than just their physical problems. Whilst this is expected in medical practice in the West (although not necessarily always practiced), it is a luxury that most clinicians in Malawi cannot afford. Dave mentioned a study he heard. Someone looked at the average amount of time a clinical officer working in a community health centre in Malawi has for each consultation. The result was harrowing – 45 seconds. It is hardly surprising that the quality of assessments is poor, and ludicrous to expect there would be a chance for social assessment or counseling.

So, it is a privilege to have the time to talk to patients.

An example of one of these crazy health centres is in the township of Ndirande on the outskirts of Blantyre. It is the poorest and most populated township within greater Blantyre. I have had a few visits to the centre representing the Tiyanjane clinic (the palliative care clinic at Queens - tiyanjane being Chichewan for ‘we are together’). The first time here, I had been invited as the Guest of Honour to the pre-Christmas function of the volunteers working for Tiyanajne. There are around 100 men and women, who volunteer their time to visit less fortunate than themselves in their homes, around the Ndirande area. I wasn’t sure if I really deserved the title of “Guest of honour”, but agreed to attend nonetheless.

We drove through the dirt roads of the township, and virtually through the middle of the market, to reach the Health Centre. Fanny, the Tiyanjane clinic cleaner, accompanied me, and showed me to where the festivities had already begun. No less than 100 men and women (mostly women) were seated on concrete pews, in an open air type hall. There was a single wooden chair at the front, facing the audience. Unfortunately, this was for me. Harriet, the inspirational nurse that I work with at Tiyanjane, was hosting the event, and ushered me over to my chair. I smiled and nodded a greeting to the sea of faces sitting before me as I took my place (what felt like a ridiculous place) on my chair. No more than 30 seconds later, the crowd had broken out into song. Malawian singing is really quite something. There is a sense of rhythm and harmony in Africa that comes naturally to its inhabitants. This song was beautiful – cheery, harmonious, and beautiful. There was a lot of clapping involved. I smiled, thinking that it was a nice song. Harriet lent over to me, and told me this was a welcome song for me. At that point, the nice song became and incredibly moving gesture. I sat, smiling, thinking to myself that it was moments like these that make harder times worthwhile. I made a speech, thanking the volunteers for all of their hard work over the year (which did seem a little ironic as a volunteer myself). I didn’t think it was all that much, but judging by the Hallelujahs and Amens in response, I guess it was okay.

The second time I visited Ndirande Health Centre, was to do a clinic. The Tiyanjane clinic at Queens runs a clinic in Ndirande every second Friday. The patients seen are those who have been referred to palliative care from a variety of people. Usually Harriet, or one of the volunteers, has seen patients in their homes and asked them to come to the clinic if there were certain issues to be sorted out. This clinic was an eye opener for me. Each patient had clear physical issues (TB, liver failure, almost all with HIV) to be sorted out. But the social issues were more problematic. It was one thing to diagnose a physical problem, prescribe a drug or two, and explain the condition to the patient and guardian. But what could we do about the fact that the patient and family had no food? Or the fact that they couldn’t afford the transport money (MK30, equivalent to about A$0.20) to go to the hospital to collect the medication. Or the fact that the husband had left once he found out his wife had HIV, and left her with 5 children under 7 and no income. These are common stories in Malawi, and were not new to me. But the situation for the patients at this clinic were just that bit more dire.

I offered to take most of these patients into Queens to collect medications. One young lady (who needed to be admitted with likely TB), accepted, and I drove her, along with her mother and daughter back to Queens. The others needed to go home first, for a variety of reasons. Who knows if they made it to the hospital for their drugs. My three passengers climbed into the back of my car. With my Chichewa as dismal as it is, there was not much conversation on the way. There was a lot of coughing however, no doubt with lots of mycobacterium being splattered all over the car interior! I wondered….how did my passengers view me? The mzungu doctor with the flashy car.

Apr 20 - Slowest City

April 20

I’m not quite sure where you get these types of statistics, nor how you quantify them in any way, but a study has apparently been done comparing the various walking speeds of the cities of the world. Blantyre, in all its glory, comes in at the very bottom; the slowest average walking speed worldwide. And sure, you may find many a fault in claims such as these, but take a couple of days of trying to get things done in this city and you very quickly realise that the studies couldn’t be too far off the mark.

From nonchalantly crossing the road in front of your car bearing down on them at speed or families wandering the halls of the hospital with a purposeful aimlessness continually blocking the corridors to the comings and goings of doctors, nurses, cleaners and every other hospital necessity. Oblivious check out attendants at stores lazily meandering despite queues of waiting customers, bar staff and waiters who seem like they’ve been set to slow motion on a video recorder, and even police, so keen to enforce their road blockades, who then wander out at speeds as if teasing you before waving you through with an overwhelming air of lethargy. They often say that Malawi has little that binds the people together as a nation, nothing that provides them with national unity given the varied backgrounds of so many differing cultures. I beg to disagree. Never before have I met a collective group of people who are so seemingly intent on lacking intent.

And why are they so slow you may ask? A mixture of many reasons I feel. The general lack of urgency in all aspects of life here from the top to the bottom of society, many people with very little to actually occupy their day, perhaps a lack of any definite structure or deadlines in most sectors of business, some would even say it’s inherent in the people.

And the best way to deal with all this? Stop rushing, this is Malawi my friend. Slow it most certainly is.

Mar 31 - Tragedy

March 31

For those who doubted the seriousness of witchcraft here in Malawi, this is an article taken from The Daily Times this morning. What a morning to choose to buy the paper to give our visitors, Nick, Lou & Matt, an idea of Malawian journalism (and this is word for word, mistakes and all)…

Residents of Bangwe Township in Blantyre on Saturday woke up to a shocker when a 30-year-old Agnes Gadama and her sister Catherine Kamanga, 23, allegedly burnt two children to ashes as ritual sacrifice to end their problems.
The women claimed they carried out the rituals to cast away demons they suspected to be the work of witchcraft.
The two, who are currently remanded at Bangwe Police Unit, are reported to have been on fasting with intense prayers for one week.
They claimed that two children – who belonged to Gadama – had demons.
Limbe Police spokesperson Chifundo Chibwezo said in an interview yesterday that they found the two children, Yankho Gadama, 9, and Martin Gadama, 6, already dead when they arrived at the scene of the tragedy following a public tip.
Chibwezo said the two women and five children locked themselves inside a house and lit a fire that left the whole house engulfed in thick smoke.
As the fire burnt and smoke made breathing difficult, the two women prayer and spoke in tongues to challenge th powers of witchcraft that were allegedly cast on the two sacrificed children.
“Gadama and Kamanga claim that their neighbours were teaching the deceased children witchcraft, so they were fasting and praying ceaselessly for one week to deal with the problem.
“But eyewitnesses told us that the two were burning the children one by one for the sacrifice ritual until neighbours decided to intervene after becoming suspicious,” said Chibwezo.
Eyewitnesses in Bangwe before burning the children, the women would grab one and bang their head on a rock to kill them.
Gadama now remains with one child, James, who is one year old and is now admitted at Queen Elizabeth Central Hospital together with Kamanga’s child, Pemphero Phiri, 8.
The two children suffered suffocation resulting from the dangerous smoke, which engulfed the building in the day of the tragedy.
In an interview yesterday, Gadama expressed disbelief that her two children died from burning as a result of the sacrifice ritual that she allegedly offered to God after a weeklong fasting.
Gadama said it all started on Monday last week when she decided to cast away the demons in her children.
“Yankho and Martin were showing signs that they had demons resulting from witchcraft. They were very rude and misbehaved a lot.
“When I quizzed them, they disclosed that one of our neighbour was teaching them witchcraft and taking them on witchcraft escapades at night. Then I decided them to Assemblies of God where a pastor told me that it was difficult for my children to be bailed out of witchcraft,” Gadama, an Assemblies of God faithful, claimed.
She claimed to have witnessed strange incidents in the house, which she shared with her sister and children. Gadama suspected witchcraft in all this.
“The night before the tragedy, I nearly died due to choking as something just got stuck in my throat. It was terrible because I there was blood coming from my private parts and foam from my mouth. I prayed hard to fight the demons. At that time my deceased children were fast asleep. And in the morning of Saturday, I just saw a crowd of people outside my house.
“The people started beating me hard, claiming that I had killed my children but I know nothing about all of this. Later I just found myself here at the police but I do not know what wrong I have done,” said Gadama, looking confused.
However, Chibwezo said the deceased children were reportedly left without food for one week when their parents were fasting and praying.
The women were staying in the house with the four children as their husbands were currently at Chichiri prison “for work-related crimes.”
Gadama and Kamanga, who hail from Mwazanduwa Village, Traditional Authority Kanyenda in Nkotakota would be charged with murder for allegedly killing the two children contrary to section 209 of the Penal Code.
Postmortem of the children’s bodies would be carried out this morning at College of Medicine in Blantyre.

The other two children were indeed admitted at our hospital, both in a definite state of starvation. Make up your own mind.

Mar 21 - Tea Totalling

March 21


Two kwacha, forty-eight tambala. Just under 2 Australian cents.

That’s how much you’ll be paid by the estates for your work picking an entire kilogram of tea leaves – and let’s face it, they’re not the heaviest of things. Okay, so a good tea picker can pluck somewhere in the vicinity of 200 kilograms per day, but that’s some seriously back breaking work for only AUS$4. A tough living by anyone’s standards. These guys, numbering in their hundreds, walk the verdant greens of the plentiful tea estates day in day out, the backdrop of the stunning cliffs of Mount Mulanje becoming a bland normality, as they ply their trade.

Bizarrely, it is against this poverty that we on our Easter break head up the slopes of the mountain for a long weekend of hiking, photographing waterfalls and rocky peaks, drinking wine and luxuriating in the efforts of others labouring under the weight of our bags. That said, Mulanje was once again an unforgettable few days. Our seventh time up since living here and the mountain still never ceases to amaze with its natural beauty and unending diversity. Easter being a particularly picturesque time of year, with the wet season having eased, leaving crisp air and brilliant greens, flowers in abundance and water filling the pools and falls at every turn. We even discovered a few more huts we had not yet visited, situated in the almost surreal beauty of sweeping valleys, precipitous rock clad peaks and seemingly endless streams of untainted fresh mountain water. A truly relaxing four day long weekend; why would anyone trade this backyard in for anything else?

At least the porters, for whom this is their only form of income, get a decent wage for their efforts. 900 kwacha per day for four days, plus an extra day tip. That’s 4500 kwacha, or the equivalent of a reasonable monthly salary for many of the country’s non-city dwellers, in one weekend of work. One can hardly blame them for seeming overly keen for your business the moment you turn up in your nice cars with your fancy trekking boots and waterproof jackets, all unimaginably unaffordable luxuries to them. Yet they wear their packs with uncomplaining joviality, practically running up and down the sheer slopes of the massif in their flip-flops or bare feet (many of them run the annual Porter’s Race, a 26km course up the mountain, across and then down again – and they do it in a touch over 2 hours!), happy for the income they can then take back to their families.



And what do the efforts of a tea pickers get them, because we all know that AUS$4 per day wouldn’t go too far in Australia. One tomato costs 15 kwacha even in cheaper areas of Mulanje… that’s six kilograms of tea to be picked just to buy one single tomato. And if they want a beer at the end of a hard day’s work? That will be 30 kilos more tea my friend. TIA.

Mar 4 - Cosmopolitan Tanzania?

March 4

If you had have told me nine months ago that we would visit a country such as Tanzania after living in Malawi and consider it nothing short of cosmopolitan, I would have laughed in your face. Yet such is the stark poverty and lack of western resources or communication means, that this is exactly the feeling one gets coming from Malawi. Nice roads, food cooked with spices, a choice of semi-decent restaurants, locals with enough money to actually eat at a sit down affair for lunch, the majority of village houses with tin roofs, a cinema, taxis, buildings more than a couple of stories high, people out after dark, an airport that actually looks (and works) like an airport, a choice of palatable beers, road signs, drivers with a vague idea (and only vague) of how to drive. The list is unending. Tanzania is in so many indescribable ways an absolute quantum leap ahead of Malawi – yet Tanzania still sits down at 159 0f 177 countries on the WHO Human Development Index, only 5 positions above Malawi.



Since living in a country with the overwhelming poverty of Malawi, we have somewhat changed our views of the throngs of beggars who constantly harangue you as an mzungu, and it is not until you visit a country that would normally look so poor to unaccustomed Western eyes that you quite realise where you live.

And just in case we were a little homesick when in Tanzania, missing the disheveled, chaotic life of good old Malawi, the national airline kept up some gentle reminders for us. Air Malawi, or Air Where-Are-We as it has become colloquially known as after its string of countless monumental stuff ups, certainly kept us guessing. We did manage to get to Dar es Salaam on our original direct flight, but not before four different time delays (and subsequently a rather worrying number of Greens at the airport lounge dampening our increasing incredulousness) totaling almost nine hours.


The journey home wasn’t quite so smooth. Two days before departing we were called with the news that our wonderful national carrier had cancelled almost all flights, with ours being included in the axings (apparently if you refuse to pay your landing fees and route charges after the seventieth warning they ground your planes and call you bankrupt… go figure?). After many phone calls, a few travel agent visits, a couple of ticket re-issuings and innumerable options explored, we finally found our way home. Dar-Jo’burg, Jo’burg-Lilongwe, Lilongwe-Blantyre. Sixteen hours late in the middle of the night.

The ability to laugh is a valuable asset around here.

Mar 2 - Kili Time

March 2

A 400-metre vertical ascent at over 1000-metres above sea level, including a 10km constant uphill grind, against some of the fastest runners this planet has to offer – these guys run a marathon faster than most of us could hope to sprint. Add to this a generous lashing of equatorial heat and the colourful disorganization of myriad cars and villagers competing for the road you run on. Not an easy undertaking at the best of times, let alone for your first marathon. Heth the full, myself the half… that was the plan. Not only was this our goal, but we had convinced four others from Blantyre to join us, none of whom had run anything like a marathon before.

Thus the contingent from the ‘Blantyre Hash’ set out to conquer the Kili Marathon, as well as using it as a very nice excuse for some time out of the day to day routine of life in Malawi. After a night in Dar, the comparatively immense capital of Tanzania, then some lapping it up in the luxury of the San Salinero Hotel in Moshi, the nearest town to Kili, we made out way down to the very African dominated Moshi Stadium for the start. Amongst the blaring music permeating the many haphazard sponsor & food tents, and the hordes of intrigued onlookers in the stadium, stood some rather alarmingly fit looking, rake thin black guys who would have looked more at home on your television set watching the Olympics than at the same event we had turned up for. Not exactly confidence inspiring, but fun all the same.

At the stroke of 6am, minutes after first light ripped its way out of the darkness and across the dusty ground in a blaze of orange, bringing with it a distinct air of expectancy, the gun went as the three hundred or so full marathon runners, Heth & Kat included, bounded out of the stadium… a few a little more briskly than others. Twenty minutes later the twelve hundred-strong runners of the half marathon followed suit in a flurry of legs and dust. And no more than a few minutes into the run, with locals lining the streets and cheering in celebration, the behemoth of Africa’s highest peak sprang from beneath the clouds to sit majestically over the entire event, a full view of her snow capped beauty greeting you the majority of the time… hard to beat this for a marathon setting.

As I came to kilometre 18 of the half marathon, having just passed Heth starting the 10km uphill slog in the opposite direction, I was met with new levels of enthusiastic cheering from the sidelines. Buoyed by this I lengthened my stride in this downhill section, then five seconds later was overtaken by a flurry of fanfare and cars… and the leader of the full marathon positively bounding along at somewhere in the vicinity of 20km/h, making me feel like I was doing my best to run backwards. He managed to set a new Kilimanjaro Marathon record, at a lazy 4h 13m 06s. Not bad considering the world record sits less than 10 minutes less than this, on flat ground.

Without shattering any land speed records ourselves we all came in with respectable times, and were even treated to the hospitality of food and drinks in the Kilimanjaro Hash tent afterwards given we were there representing Blantyre. And what better way to celebrate such an achievement (particularly from Heth & Kat) than a few days of cold beers, indulgent seafood, diving, sunbaking and soaking up the relaxing vibe of Zanzibar. Perfect.

Feb 22 - Transient friends

February 22

One of the distinct disadvantages of living in a country where the overwhelming majority of whites are expats, and the bulk of these are short term, is the transience of existence and friendships. We have quickly realised that even though we are only here for one year, this is longer than many and the friends you have come and go with a rather unsettling regularity. And as much as we have several black African friends, the cultural gap between so many of us means that the majority of socializing is still predominantly whites.

I think it comes in waves of enthusiasm too. At times, and particularly when you first arrive in a new place, you spend a good deal of energy invested in meeting new people and socializing whenever you can, but after a while you become settled in a particular social scene and the effort of meeting others wanes. The problem then, as distinct from life in Australia, is that the mat is pulled from under you at regular intervals, meaning friends who you have spent so much time with simply up and leave. Not exactly conducive to long lasting relationships.




The flip side to all this, and perhaps what keeps so many going over here, is the immense diversity and constant flux of social and even work scenes that continually pass by, meaning never a dull moment, and always someone out doing something that you can join along with. Outdoor activities are another huge bonus. With so many different walks of life here, the range of sports and activities that are always buzzing around is immeasurable, and more than easy to throw yourself into.

So I guess both good and bad, and one may argue more either way. Yet despite this, it is always a little saddening when you are invited along to yet another going away party of yet another close friend. The good news, is that there’s always another housewarming just around the corner.

Feb 17 - One Year In

February 17

Paper is the first year, right?

We awoke in Zomba this morning, away for a couple of nights for the Hash weekend, to a table full of various attempts at origami by our friends: a couple of small paper boxes with paper flowers in them, a paper lily, a snap dragon, even a few paper aeroplanes. Nothing extravagant, but thoughtful all the same. A typically Malawian way to celebrate your wedding anniversary… low key and very slap dash.

Climbing dilapidated bridges over vine clad rivers, fighting your way through the tenacious greens of the undergrowth, passing meandering cows grazing and local bikes loaded to the point of hilarity with illegally cut wood, quartz stone sellers and roadside strawberry and raspberry vendors. Views that stretch as far as the horizon will permit, progressively hazier peaks rising into the blues and fluffy whites. Children running alongside with their 'mungu' calls playfully bouncing around, then older locals hesitantly querying why you are coating their road in white lime dust circles and dots, fearing witchcraft at work. These are the average encounters of setting a Hash route, something Angela, Yaseen and I came across in profusion that weekend.

There wouldn’t be too many couples that in their first year of marriage have lived on two continents, visited twenty-one countries, worked in one of the poorest countries in the world (and possibly the poorest non-worn torn country) and managed a honeymoon dog sledding in minus thirty degree temperatures in the middle of a Siberian winter… nor perhaps many couples who would want to. And what better way to celebrate than with a few paper aeroplanes then a morning run.

Feb 13 - The Death March

February 13

Staring into the fixed, dilated pupils almost popping out of the skeletal features of yet another malnourished child as he takes his last breath. Nonchalantly reviewing patient after patient, comatose or fitting from malaria. Hearing the all too common death statistics from the last twenty four hours in our department. There’s some things about working here which, rather bizarrely, become routine. The piercing wails from the mother of a recently deceased patient, accompanied by the rhythmic African consolations of the singing group behind them as they move slowly down the hallways, the small lifeless body covered in a sheet, is not one of these. Every single time you file respectfully past a makeshift funerary procession in the hospital corridors, the other mothers from the ward walking behind the deceased and their family as a sign of respect, a chill runs right down your spine.

Many who haven’t worked here, haven’t seen the hardship and loss that these people endure on an alarmingly frequent basis, often think life is cheaper here than in the developed world. Yet you watch a mother scream helplessly until she collapses with exhaustion at the death of her 4 year old son, or the tears that gradually well up in her eyes as the hopelessness of a resuscitation on her 2 year old daughter slowly dawn on her. You will very quickly learn that life here is every bit as important, every bit as sacred and special, as each and every one ‘at home.’ Yet the pain so many here experience so often is nothing short of numbing. HIV, tuberculosis, malaria, malnutrition. These foreign conditions for many reach so often into the lives of countless ordinary Malawians that one cannot be shamed for thinking that they could be somewhat taken for granted, yet more wrong you could not be. The educated, the wealthy, even the health workers themselves; no one is immune. It is most certainly not a case of ‘it only happens to them.’

And for the most part death, burial and the ceremonial processions that accompany these are of utmost importance to most traditional Malawians. Much money is spent on coffins, a village halts for a funeral and anyone involved in the life of the deceased moves heaven and earth to visit and pay their last respects to the deceased. In the adult world, for Heather in her palliative care role, getting a patient home before dying is highly paramount given the emphasis placed on the village-based rituals that follow.

Despite all this death, despite the under five mortality continuing to sit somewhere around 1 in 8 or higher, despite the average life expectancy in Malawi floating at an abhorrent 40 years of age, and despite the morning death statistics becoming an almost cursory routine, life is never cheap. Nor, despite all this, does that chill down the spine become any less haunting with each and every death march.

Feb 8 - O2 & NG

Oxygen & nasogastric tubes… hallelujah, Amen!

February 8

Every so often, an incident occurs that reaffirms why you’re here working in Malawi. This was one of them.

Culturally, both the delivery of oxygen and the use of nasogastric tubes (small tubes that run through the nose into the stomach to facilitate feeding in patients who are unable to take nutrition orally) are very much frowned upon. The precise reasons are elusive, although in short they are seen as a cause of death, rather than a treatment method, and the phenomenal lack of education here makes changing this perpetuated myth an extremely difficult undertaking. And one can hardly blame mothers when they watch the sickest of children, of whom the vast majority die, invariably receive oxygen and often a nasogastric tube. A real catch-22, given we cannot use them in a more widespread manner in order for them to be seen more as routine care due to lack of resources and funding. The upshot is that a disturbingly large number of families not only refuse both of these managements for their terribly sick children, but will remove them and sometimes even abscond as a result.

Magdalena was a particularly unwell girl of about 12 years with miliary (widespread) tuberculosis. She had severe malnutrition causing wasting to the point where she didn’t even have the muscle bulk to sit up and debilitating pressure sores as a result. She was with us in the malnutrition unit for around three months. It was a daily battle to ensure she was receiving adequate nutrition – along comes the evil spectre of a nasogastric tube – as well as trying to treat secondary infections such as pneumonia all too frequently – bring on evil number two, oxygen. As you can imagine, the circular arguments with her and her mother were somewhat disheartening, not to mention frustrating. My only solace to our interactions was Magdalena’s laugh, which broke the look of sheer anguish on her weathered face every time I tried out my rather infantile Chichewa. Anyway, after a protracted stay on our ward, she finally got to the point where we felt home was appropriate… and by then she could even greet me in English. That was some time in November.

Sitting in the malnutrition ward today going through the daily round of now over ninety patients (slightly ridiculous numbers for a twenty bed ward) Magdalena and her mother came to visit. After gaining the attention of all the other mothers on the ward – fathers being a very rare presence – her mother began to tell Magdalena’s story from her time in the ward. Although my Chichewa is still far from conversational, I could understand the drift of what was said. Despite all the daily tussles we had about her daughter’s care and her ongoing distrust of western medical care, here she was extolling the virtues of both the nasogastric tube and oxygen, knowing full well the misplaced cultural beliefs that she herself also shared. She dramatically described how I would plead every day and she would refuse, then finally how she acquiesced. And like the stunned disbeliever dropping to the floor as they finally feel the touch of god through the preacher’s fingers in those zany evangelical services, Magdalena rose from her chair (still quite wasted and unsteady, but with no help) to the whoops of delight from the onlookers.
“Hallelujah!”
“Amen!” came the cries, clapping and Chichewan ‘oohs’ and ‘aahs’ accompanying in force.

And at the very end of all this, Magdalena’s mother singled me out, herself and her daughter beaming from ear to ear, to the cheers of the other mothers.
“Dikirani! (Wait!)” I called out as they turned to leave, “Magdalena, how are you?”
With an enormous grin she spun around and in her proudest English she yelled, “I’m fine, and how are you?”

Jan 28 - The Mayor of Blantyre

January 28

“If you were the mayor of Blantyre, what would you do to reduce the number of children injured on the city’s roads?”
This is the essay topic our final year medical students must write on during their paediatric rotation.

It’s not every day that you have to undersew a four-year-old’s temporal artery in the emergency department just to stop the immense amount of blood loss from the gruesome flap of skin that the minibus has ripped off her face. And that’s not the worst of it. A base of skull fracture. Swelling inside the head causing unconsciousness and active fitting.

Malawi apparently has more road accidents per car on the road than any other country on the continent. Although there’s not that many cars compared to the overall population (13 million people and growing by the day), the number of road accidents is alarming. All too commonly we see children coming in with smashed skulls, broken limbs, blown pupils and the like, often with no way of identifying them and no possibility of contacting their parents – you simply wait until the grape vine winds its way back to the victims home for the family to find out their child has been hospitalised. One day, two days, sometimes well over a week, despite the police searching high and low.

One is quick to blame the drivers. And let’s face it, they’re terrible. Swerving into oncoming traffic to turn a corner with no notion of indicating; driving at night with no headlights – mostly because they just don’t work; overtaking around blind corners over the crest of a hill without the slightest modicum of caution; minibuses braking without lights, stopping absolutely anywhere, mounting the curb to overtake congested traffic or belching fumes so thick you can’t even see the road in front of your car. And all this isn’t helped by a complete lack of any road signs or street lights or markings, traffic lights that don’t work (or when they do, are never paid any attention), potholes big enough to swallow your car forcing sudden and unpredictable swerving and no one to do any real enforcing of the laws.

Yet it’s not just the drivers or the roads that can be blamed for the carnage that we see. The lack of general awareness of almost all pedestrians is nothing short of mind-numbing, and for that one can only look towards the general education levels. People run out onto busy roads with absolutely no inclination that they have a 1 tonne vehicle travelling at 60km/h about to squash them into the bitumen, and if they do see you they usually give a somewhat incredulous look then continue on their merry way, making no effort at avoiding you. School children run mindlessly along the roads, oblivious to the dangers they constantly put themselves in until they are lying in an emergency department, yet their parents and guardians do nothing to stop them or educate them. Driving here is like playing a computer game, a constant stream of moving obstacles that often reduce your speeds to a crawl, although in this game you don’t get three lives until its game over.

So as the mayors of Blantyre, I think our medical students have a fair bit of material to work with in trying to solve this little problem.

Jan 24 - Rain

January 24

“When it rains, it pours.”
This expression must have been coined in Malawi. The one thing this country has no trouble with (and let’s face it, they have a few) is rain. Wet season here – and admittedly this year has been a particularly saturated affair – comes as a veritable deluge that blankets Blantyre in a matter of seconds on an almost daily basis. You go from bone dry to wringing water from your clothes in well under a minute if you’re unfortunate enough to get stuck in it. An umbrella, even for the poorest of families, seems to be a sheer necessity of life. Rivers appear on steps and roads dive a foot underwater before your eyes; potholes grow larger by the day and roof tiling wilts under the sheer force of the downpours. It is little wonder that the crops here grow as wildly as they do for the wettest months of November through February. The problem this year with the rain being so heavy, is that if it continues in this vain for much longer the maize will soon rot, providing just as much suffering as the famine-provoking drier years. Not something the general population, nor the already overburdened medical system, needs.

And the constant rain creates its own difficulties around the house too. Mushrooms growing in the bathroom (okay, maybe we need to look into how that one happened), constant small leaks in the roofing thanks to the old tiling, mould growing insidiously on most of our cane furniture giving the place a decidedly dank smell. Anything and everything is invaded by the humid, musty air that pervades the entire town. Clothes don’t dry for days after washing; mud cakes everything…
And don’t worry Melburnians, they have water restrictions here too. You can only water your garden for two hours a day, three days per week in Blantyre… because every other minute of the day its too bloody wet to venture outside! One just hopes that such a heavy wet season brings with it an early return to the welcome monotony of clear blue skies that grace the country for more than six months each year.

Jan 2 - The President

The President is Coming… ‘TIA’

January 2

The road into Queen’s, the largest and most well known hospital in the entire country, is disputably one of the worst in Malawi. A series of ever increasing potholes literally chew away the remaining bitumen with every rain as they merge into one, making each trip to and from work an adventure in itself. The wards here are also a kaleidoscope of chaos, a true tragedy by international standards in so many ways. Although we are now almost immune to the stunning odours, the noise, the squalid overcrowding, they exist on a level not known by many other parts of the world.

Yet as we returned from our brief getaway to the lake for the New Year period to begin another day of work, we met with an altogether unbelievable sight. Our road, the one that we do battle with every day in our low clearance saloon, was being filled in, smoothed over. And not just with the usual smashed up bricks that some benevolent person decides to temporize with (they usually last around a week before the potholes are growing cancerously away again)… this was real bitumen (well okay, it was actualy incinerator waste mixed with water, but let's not split hairs). Amazing!

Bouyant from our smooth passage into our offices we were then greeted with the next overwhelming, almost surreal, sight. The wards were clean. No bodies lying scattered over the floor, no foodstuffs or clothes spread carelessly about, a crisp disinfectant aroma replacing the usual fog of deodorant-devoid Africa, new bed sheets and blankets adorned each bed, and the walls and windows cleaned to a sparkle. Maybe we had entered the wrong hospital? This was certainly not the Queen’s we had come to know.

Half an hour later, in both our handover meetings, the reason for this twilight zone metamorphosis was made abundantly clear… the President was coming. Of course, there had to be a very good reason for people to suddenly care about the big ugly monster that is the Queen Elizabeth Central Hospital, the place that sees many hundred of the country’s sickest and poorest every single day of the year. And one may rightly question the sense in cleaning up one of the more abhorrent places in the country just to appease the President when it is the very place that he should see at its worst in order to generate desperately needed, yet absurdly denied, funding? Why wait until Mr. Mutharika pays a visit to do the cleaning and tidying and simple maintenance that would be a regular occurrence in any other hospital elsewhere? Shouldn’t the President be greeted by lobbying for help and extra staffing rather than smiling cleanly washed faces, nurses brimming at the site of their elected leader, music, song and festivity? They had even overfilled certain adult wards that would be hidden from view so that the showpiece wards would retain some semblance of sanity and order.

Interestingly, one of the previous Presidents toured the hospital several years prior and one of the Malawian doctors in charge of obstetrics decided that nothing would be cleaned outside the norm, women would lie crowded on the floors just as they always did and the place would look just as it does every other day. Despite the protestations of all the other staff that they would lose their jobs for performing to such a low standard if the President were to see this, his reaction was the complete opposite.
‘My women, lying on the floor like this! This cannot be. We will build them somewhere to sleep!’ We now have an entire wing of the hospital, purpose built, dedicated purely to obstetrics and gynaecology. Yet even with this example, the reaction is still the same.

We watched a rather chilling and disturbingly truthful movie last night, Blood Diamond (very enjoyable once you get over Leonardo diCaprio’s attempt at a white Zimbabwean accent). In this insight into the horrific violence precipitated by the illegal diamond trade in Sierra Leone in the 90’s, they give a very simple and very accurate (although ever so slightly tongue in cheek) answer to all the problems and questions of this rather perplexing and idiosyncratic continent… ‘T.I.A.’

This is Africa.