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?”