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.
28/1/08
24/1/08
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.
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.
2/1/08
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.
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.
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