Wednesday, August 30, 2006
Still Dancing
I checked on the little girl today. She's looking well - no fever, no seizures, physically and developmentally normal on day 7 of life.
Monday, August 28, 2006
Miracles
Thursday was a wonderful day. It didn’t start out wonderful but at 5:30 I felt great. I arrived early at Bottom to meet the usual assortment of urgent cases. Almost all 14 beds were occupied but the voice of one woman rose above everyone. Around 9am the midwife monitoring her decided that the baby was distressed. A caesarian was ordered. At 9:40 I was handed a pale listless little girl. I immediately began resuscitation. Usually the nurse who receives the baby in theatre is the one and only person responsible for that baby, luckily this time there were two medical students and a VOS anesthesiologist whose hands were free. The four of us worked on her . . . suction, bag, mask, chest compressions, drugs, oxygen. I looked at her purple lips and thought the worst but kept going. At 10:20 she cried. She cried weakly at first, then coughed, then cried a bit louder and stronger. I was so happy I could have kissed everyone in the room. Honestly, I don’t remember much about the other patients that day. I just moved from birth to nursery and back. I left her pink and squirming under the warmer that afternoon.
Of course I can’t say that everything will turn out well. There is still a chance she may die this week, and if she survives, she might have cerebral palsy, and even if she is intact physically, she might have severe mental disabilities. There are still so many miracles required to carry her through to adulthood whole, but her first miracle happened while I held her in my hands and that’s enough to make me dance and sing today.
Of course I can’t say that everything will turn out well. There is still a chance she may die this week, and if she survives, she might have cerebral palsy, and even if she is intact physically, she might have severe mental disabilities. There are still so many miracles required to carry her through to adulthood whole, but her first miracle happened while I held her in my hands and that’s enough to make me dance and sing today.
Joy
Wednesday Mr Nanthowa (aka Ireen’s dad) showed up at Bottom on a borrowed bicycle with a bag of peas and sweet potatoes from his garden. I realized that seeing him there meant he had rented a bicycle from a neighbor and then cycled 40 kilometers to deliver that bag of home grown goods to me at Bottom and put them in the trunk of my shiny car. Straight away I decided that Friday I would visit and bring a new bike. I thanked him and told him I would visit. Friday morning after a couple baby visits I went to a shop and bought a shiny new black bike for $60 (thanks to Jeff). A worker there helped me fix it with lots of green rope, so that the trunk almost closed and the handle bars just peeked out. I did fine for the first 20km but at the first bump - as I moved from paved to unpaved road - everything came loose. I retied it myself but even with my knotting skills from rock-climbing days, the trunk bounced each time I hit a good bump. Multiple times along the way I considered just leaving the bike somewhere (the clinic, the police station, etc.) and bringing him to collect it, but each time I scolded myself for the thought and continued bumping slowly along.
As I pulled up between the huts, Mrs Nanthowa emerged with a chitinge wrapped around her, fresh from bathing. She said a million things to me in Chichewa, which I didn’t understand, through smiles and laughter and led me to a mat indoors to wait while she dressed. Mr Nanthowa soon appeared, sat on the mat, and shook my hand. He told me I should park my car in the shade. I asked him if he noticed what I brought for him. Instantly his eyes widened, an enormous smile spread across his face, and he took my hand. I was laughing and he was saying, “Congratulations! Congratulations!”
We unloaded the bike and moved it inside where he began the assembly. As family members came by he proudly showed them the bike and in response they clicked their tongues and shook my hand. I told him about my friend giving the money and he gave me his address, enchanted by the thought of sharing his happiness and gratitude with this kind stranger.
Of course before I left, we ate nsima. I told them that my parents would be coming (they’re coming to Malawi in October!) and Mr. Nanthowa said I had to bring them there. He said, “You’re roots are here. Your parents can stay 2 or 3 days. You can come and go but your parents should stay and we’ll kill a goat. And that’s a promise.” I love the idea of my parents in the village sharing nsima with Mr and Mrs Nanthowa, and the entire village present for a goat roast, but I can’t quite imagine them sleeping on the grass mats. Maybe a morning will suffice.
As I pulled up between the huts, Mrs Nanthowa emerged with a chitinge wrapped around her, fresh from bathing. She said a million things to me in Chichewa, which I didn’t understand, through smiles and laughter and led me to a mat indoors to wait while she dressed. Mr Nanthowa soon appeared, sat on the mat, and shook my hand. He told me I should park my car in the shade. I asked him if he noticed what I brought for him. Instantly his eyes widened, an enormous smile spread across his face, and he took my hand. I was laughing and he was saying, “Congratulations! Congratulations!”
We unloaded the bike and moved it inside where he began the assembly. As family members came by he proudly showed them the bike and in response they clicked their tongues and shook my hand. I told him about my friend giving the money and he gave me his address, enchanted by the thought of sharing his happiness and gratitude with this kind stranger.
Of course before I left, we ate nsima. I told them that my parents would be coming (they’re coming to Malawi in October!) and Mr. Nanthowa said I had to bring them there. He said, “You’re roots are here. Your parents can stay 2 or 3 days. You can come and go but your parents should stay and we’ll kill a goat. And that’s a promise.” I love the idea of my parents in the village sharing nsima with Mr and Mrs Nanthowa, and the entire village present for a goat roast, but I can’t quite imagine them sleeping on the grass mats. Maybe a morning will suffice.
Neighbors
Until last month Masauko worked at the US Embassy as a guard. His company paid him 1250MK a week for 72 hours of work. I never met him until the day he approached me and told me he wanted to go back to school. He said he realized that a better future did not exist for him as a guard. He is 25, married, with two children. He is the oldest of 8. Both parents died and left him responsible for the well being of his younger siblings. On 5,000MK a month he was barely surviving and decided that he should get his MSCE (the equivalent of a high school diploma). He told me about his hopes, about his family, about walking to work in the dark to arrive by 6am and walking home in the dark after 6pm. He told me about meeting hyenas on those walks.
He found a school and I agreed to sponsor him. A couple weeks later he invited me to his home. That day we arrived at an adobe structure no bigger than 8 by 10ft, divided into two small rooms that share one broken window. He lives together with his wife, their children, and her brother. I could see spots of sky through the roof. He said he moved into this bigger home from the smaller one that stood beside it. He said the window was broken by a thief in the night. He showed me his notebooks - line after line of notes copied in his neat crisp handwriting. He showed me the cracks in the soles of his shoes. He apologized for not offering me something saying they had nothing to eat themselves all day. I looked from him to his neighbor, an old woman who now occupied the “old” house. I asked him why he approached me. With a laugh he told me that he heard I helped orphans and thought since he was an orphan, I might help him too.
I thought, “What else can I do?” I desperately refuse to accept the status quo of a world that says this is okay and turns away. So I’ll dig in, one little bite at a time. Then someone needs to help his neighbor, and her family, and their neighbors too.
He found a school and I agreed to sponsor him. A couple weeks later he invited me to his home. That day we arrived at an adobe structure no bigger than 8 by 10ft, divided into two small rooms that share one broken window. He lives together with his wife, their children, and her brother. I could see spots of sky through the roof. He said he moved into this bigger home from the smaller one that stood beside it. He said the window was broken by a thief in the night. He showed me his notebooks - line after line of notes copied in his neat crisp handwriting. He showed me the cracks in the soles of his shoes. He apologized for not offering me something saying they had nothing to eat themselves all day. I looked from him to his neighbor, an old woman who now occupied the “old” house. I asked him why he approached me. With a laugh he told me that he heard I helped orphans and thought since he was an orphan, I might help him too.
I thought, “What else can I do?” I desperately refuse to accept the status quo of a world that says this is okay and turns away. So I’ll dig in, one little bite at a time. Then someone needs to help his neighbor, and her family, and their neighbors too.
Monday, August 21, 2006
Biodiversity, then and now
In response to my post about the visit to Stacia and Kristof's farm, I received the question, “What happened in Malawi to get people cut off from their native plants?” Here is Stacia's response:
There have been many events that have eroded indigenous knowledge, and Malawi is not the only culture that has faced this challenge. The world has narrowed its diet considerably in the past 80 or so years since we have been taken over by conventional agriculture, mass-processing, mass-distribution, extensive advertising, increased commercialism, changes in the work force, lifestyles, and other cultural changes.
For Malawi, the main events seems to be colonialism encouraging the growing and use of foods known to the colonialists and the dictator Dr. Banda continuing on the same track. Reports are that more than 'encouragement' took place when it came to maize; people were forced to change to maize and there were dire consequences if they didn't follow orders. The colonial-based schools introduced a curriculum based on western methods of growing food which replaced the traditional education of learning local plants and animals. For more than 100 years, everything "local" was looked down upon as something for "poor" and "backward" people. The mentality was widespread in every sector (such as health, education, agriculture, economics, etc.). Even today, government programmes focus their work on western ideas and methods - although it is now changing as people are realizing the agricultural and nutritional benefits of the local plants. They are easier to grow, they take little input and effort, they withstand local insects and weather patterns, and they generally are more nutrient-dense foods.
There have been many events that have eroded indigenous knowledge, and Malawi is not the only culture that has faced this challenge. The world has narrowed its diet considerably in the past 80 or so years since we have been taken over by conventional agriculture, mass-processing, mass-distribution, extensive advertising, increased commercialism, changes in the work force, lifestyles, and other cultural changes.
For Malawi, the main events seems to be colonialism encouraging the growing and use of foods known to the colonialists and the dictator Dr. Banda continuing on the same track. Reports are that more than 'encouragement' took place when it came to maize; people were forced to change to maize and there were dire consequences if they didn't follow orders. The colonial-based schools introduced a curriculum based on western methods of growing food which replaced the traditional education of learning local plants and animals. For more than 100 years, everything "local" was looked down upon as something for "poor" and "backward" people. The mentality was widespread in every sector (such as health, education, agriculture, economics, etc.). Even today, government programmes focus their work on western ideas and methods - although it is now changing as people are realizing the agricultural and nutritional benefits of the local plants. They are easier to grow, they take little input and effort, they withstand local insects and weather patterns, and they generally are more nutrient-dense foods.
Goodbyes
One week after Deb and Zack left, Clement and I tearfully escorted Dana and MacPharlen to the airport. Dana and Mac have been wonderful friends to the two of us pretty much since I arrived in the country. Dana completed two tours with Peace Corps here and in the meantime met MacPharlen. They married two years ago and as she boarded the plane to return "home" she was weeks away from completing her seventh year in Malawi.
Most recently Dana worked for Jesuit Refugee Services as the education coordinator on the refugee camp in Dowa. There are two small camps in Malawi mostly housing Rwandans, Burundians, and Congolese. Dowa is the larger of the camps, inhabited by close to 4,000 refugees. In addition to overseeing the schools on the camp, Dana and her Malawian counterpart began an anti-human trafficking campaign as well as a campaign to register all unaccompanied minors.
Human trafficking is an enormous global problem and unsurprisingly most of those trafficked are children and uneducated women from low-income countries, who are either sold by their own families or persuaded by lies of a better life. The networks are incredibly, someone can disappear from Malawi today and then arrive in a brothel in Europe months later. Most people in the developing world never receive a birth certificate, or only receive them with an explicit request and a lot of footwork. To be a bit dramatic this means there is essentially no record of the existence millions of people. The lack of a central registry in turn makes it more difficult to advocate for and rescue trafficked people. Although clearly passionate about her students and teachers, Dana found her calling in the anti-trafficking work. Last fall she applied to schools, this month she will begin a social work program at Case Western and hopes to also get her law degree there.
MacPharlen is an electrical engineer; very warm and hardworking. Escom is the only power company in Malawi and for the past seven years Mac has essentially been responsible for the section of the company serving the entire central region of Malawi. Up until last month he had never traveled outside the country and although he was excited by the possibility of continuing his education he always seemed a bit nervous when I asked him how he felt about leaving. In truth he was leaving his life. Dana frequently joked that it was his turn to learn about her culture although I imagined she was almost as nervous to see the evolution of "her culture" since her last trip home.
Over the past year and a half Dana and I spent countless hours talking about home; feeding each other bits of our histories, frantically trying to catch up on everything that transpired in all the years we were strangers. Of course we also spent hours talking about our relationships, the good and the frustrating, and laughing frequently. I know Clement and Mac also appreciated the links between the four of us. Truly over our short time together our relationship became like family.
On August third I felt excited but anxious for the two of them, entering and re-entering an unknown world; leaving all the connections of home. As I watched their tiny figures wave and board the plane through my tears I realized all my sadness came from their departure and concern for them and none from being left. For now, Malawi is home.
Most recently Dana worked for Jesuit Refugee Services as the education coordinator on the refugee camp in Dowa. There are two small camps in Malawi mostly housing Rwandans, Burundians, and Congolese. Dowa is the larger of the camps, inhabited by close to 4,000 refugees. In addition to overseeing the schools on the camp, Dana and her Malawian counterpart began an anti-human trafficking campaign as well as a campaign to register all unaccompanied minors.
Human trafficking is an enormous global problem and unsurprisingly most of those trafficked are children and uneducated women from low-income countries, who are either sold by their own families or persuaded by lies of a better life. The networks are incredibly, someone can disappear from Malawi today and then arrive in a brothel in Europe months later. Most people in the developing world never receive a birth certificate, or only receive them with an explicit request and a lot of footwork. To be a bit dramatic this means there is essentially no record of the existence millions of people. The lack of a central registry in turn makes it more difficult to advocate for and rescue trafficked people. Although clearly passionate about her students and teachers, Dana found her calling in the anti-trafficking work. Last fall she applied to schools, this month she will begin a social work program at Case Western and hopes to also get her law degree there.
MacPharlen is an electrical engineer; very warm and hardworking. Escom is the only power company in Malawi and for the past seven years Mac has essentially been responsible for the section of the company serving the entire central region of Malawi. Up until last month he had never traveled outside the country and although he was excited by the possibility of continuing his education he always seemed a bit nervous when I asked him how he felt about leaving. In truth he was leaving his life. Dana frequently joked that it was his turn to learn about her culture although I imagined she was almost as nervous to see the evolution of "her culture" since her last trip home.
Over the past year and a half Dana and I spent countless hours talking about home; feeding each other bits of our histories, frantically trying to catch up on everything that transpired in all the years we were strangers. Of course we also spent hours talking about our relationships, the good and the frustrating, and laughing frequently. I know Clement and Mac also appreciated the links between the four of us. Truly over our short time together our relationship became like family.
On August third I felt excited but anxious for the two of them, entering and re-entering an unknown world; leaving all the connections of home. As I watched their tiny figures wave and board the plane through my tears I realized all my sadness came from their departure and concern for them and none from being left. For now, Malawi is home.
Tuesday, August 08, 2006
A Busy Day
My beloved friends Deb and Zack left Malawi for the States on July 27th. Deb is a fourth year medical student at the University of Pittsburgh. She took a year off school to accompany her husband to Malawi. Zack works for Baobab, a small NGO that is setting up computers in the wards at Kamuzu Central Hospital (really incredibly stuff). During her year in Malawi Deb has been my partner in the labor ward and very good friend. She is seven months pregnant and I'm ashamed to say I gave her pretty shoddy prenatal care; I will definitely miss seeing the birth and the introduction of her little one to this world. Before she left, Deb and I has a nice lazy couple of days at Nkwazi lodge - a little place on the lake about 5 hours North of Lilongwe - and we also went to see Ireen again so that they could say goodbye.
I still have not learned my lesson about timing here. Saturday morning we arrived in the village at 11:30 (an hour drive from Lilongwe) and I was supposed to meet Frank and his group at 1pm. Ireen and her parents were at church so we waiting for someone to let them know we were there. Deb had brought photos from a previous visit, including pictures of Alinafe, and those excitedly flowed through fingers as we waited. Finally Ireen and her father appeared; Ireen laughing hysterically at our visit and then crying hysterically at the sight of her lost little girl in the photos. Her father kindly took the pictures from her hands and said, "It happens."
By that time we should have already been making our way back to Lilongwe but Ireen's dad convinced us that we needed to collect her mother from the church and then the mother insisted that we eat nsima. Finally, well after 1pm, we said our goodbyes and let them load the car with pumpkins, popcorn, and two chickens. I promised Ireen's dad that I would bring him a book on HIV (by his request) and a bicycle - since his was beyond repair and had provided the sole means to transport his produce from the garden to the market.
Around 3pm I met Frank and three women from his group who were still waiting for me. I loaded them in the car and we left to see Stacia and Kristof's farm, a short distance outside Lilongwe. Stacia and Kristof came to Malawi as Peace Corps volunteers but have now been here for over a decade. Stacia is a nutritionist and Kristof is an agriculturalist and they both speak fluent Chichewa. On their table Stacia had arranged an elaborate display of dried produce and grains grown in Malawi. She gave a nutrition talk to our small group of five emphasizing dietary diversity and then Kristof led us on a tour of their garden talking to the women about permiculture and crop diversity. The afternoon was rounded off by tea and popcorn made from their produce and a show and tell of a low cost fuel-efficient stove and "charcoal" made from recycled paper. The women accepted a variety of seeds, took notes, and were eager to buy several of the stoves (they are sold in another town outside Lilongwe and we have not yet purchased them). Driving back with their buzz of conversation felt great; although I could not understand much, I certainly sensed the enthusiasm and also felt excited about the possibilities.
I dropped off Frank, the three women, and two chickens just before 6pm; Memory had been waiting for me at the Nature Sanctuary since 5pm. Memory is 16, she is a bright girl with big ambitions. She is an orphan. I am paying her school fees and told her that if she did well on her exams, I would take her to dinner. The Nature Sanctuary is a park that includes a small area of caged animals (hyena, python, baboons, crocs), a large area with the same animals roaming free (you don't often see them but can hear the hyenas at night), and a restaurant with reasonably priced Malawian food that is open in the evenings (a rarity here). It was a sweet evening; I could see that she enjoyed it, even after waiting for me for an hour in the cold. I drove her home, met a few of her cousins, then drove myself home to a hot shower and bed.
I still have not learned my lesson about timing here. Saturday morning we arrived in the village at 11:30 (an hour drive from Lilongwe) and I was supposed to meet Frank and his group at 1pm. Ireen and her parents were at church so we waiting for someone to let them know we were there. Deb had brought photos from a previous visit, including pictures of Alinafe, and those excitedly flowed through fingers as we waited. Finally Ireen and her father appeared; Ireen laughing hysterically at our visit and then crying hysterically at the sight of her lost little girl in the photos. Her father kindly took the pictures from her hands and said, "It happens."
By that time we should have already been making our way back to Lilongwe but Ireen's dad convinced us that we needed to collect her mother from the church and then the mother insisted that we eat nsima. Finally, well after 1pm, we said our goodbyes and let them load the car with pumpkins, popcorn, and two chickens. I promised Ireen's dad that I would bring him a book on HIV (by his request) and a bicycle - since his was beyond repair and had provided the sole means to transport his produce from the garden to the market.
Around 3pm I met Frank and three women from his group who were still waiting for me. I loaded them in the car and we left to see Stacia and Kristof's farm, a short distance outside Lilongwe. Stacia and Kristof came to Malawi as Peace Corps volunteers but have now been here for over a decade. Stacia is a nutritionist and Kristof is an agriculturalist and they both speak fluent Chichewa. On their table Stacia had arranged an elaborate display of dried produce and grains grown in Malawi. She gave a nutrition talk to our small group of five emphasizing dietary diversity and then Kristof led us on a tour of their garden talking to the women about permiculture and crop diversity. The afternoon was rounded off by tea and popcorn made from their produce and a show and tell of a low cost fuel-efficient stove and "charcoal" made from recycled paper. The women accepted a variety of seeds, took notes, and were eager to buy several of the stoves (they are sold in another town outside Lilongwe and we have not yet purchased them). Driving back with their buzz of conversation felt great; although I could not understand much, I certainly sensed the enthusiasm and also felt excited about the possibilities.
I dropped off Frank, the three women, and two chickens just before 6pm; Memory had been waiting for me at the Nature Sanctuary since 5pm. Memory is 16, she is a bright girl with big ambitions. She is an orphan. I am paying her school fees and told her that if she did well on her exams, I would take her to dinner. The Nature Sanctuary is a park that includes a small area of caged animals (hyena, python, baboons, crocs), a large area with the same animals roaming free (you don't often see them but can hear the hyenas at night), and a restaurant with reasonably priced Malawian food that is open in the evenings (a rarity here). It was a sweet evening; I could see that she enjoyed it, even after waiting for me for an hour in the cold. I drove her home, met a few of her cousins, then drove myself home to a hot shower and bed.
Monday, August 07, 2006
Amazing Energy
Sister Namaleu told me months ago about her oldest daughter's pregnancy. Chimwemwe, the first of six girls, was pregnant with the first grandchild who everyone hoped would be a boy. Namaleu asked me to attend Chimwemwe during the birth and I was excited about the prospect.
According to a hazy memory of her last period, her due date was set sometime in June, but June came and went, early July came and went, and still the baby gave no signs that it was ready to see the world. I met Chimwemwe for the first time on July 16 and by a conservative estimate she was well into the 42nd week of the pregnancy (as the pregnancy continues past 42 weeks there is a sharp increase in the risk of stillbirth as the placenta begins to deteriorate). The following day I scanned her at Bottom and could see that the baby was active and had plenty of fluid; her cervix was soft but closed - a sign that labor was still a couple days off. We decided to meet early in the following week for another scan and possibly an induction.
On the 19th I had planned a three day trip to the lake with my friend Deb who would be leaving Malawi permanently on the 27th. I very much wanted to be present for Chimwemwe's birth but both Chim and her mom knew that I would be away for a couple days. Chimwemwe seemed confident that the baby was well and would wait for my return.
Sunday Chimwemwe had mild contractions and neither she nor her mother slept but Monday the contractions stopped. Monday night and Tuesday the pattern repeated. Tuesday night at 1:30am sister Namaleu called and said they were ready to go to the hospital. Pulling myself from my warm cozy sleep, I momentarily doubted my calling as a midwife, and only with great effort escaped the magnetism of my bed. I expected that Chimwemwe was still in early labor and wanted to talk to her or examine her before we left for the hospital, but when I reached their house she and her mother were already standing out in the cold night bundled in chitengies, bags ready at their feet. I realized later that when six girls share a bedroom and when the laboring women shares a twin bed with her younger sister, the hospital is a better option than home, even in early labor. (If I hadn't had a friend sleeping in my guest room I would have brought them to my place.)
When we arrived at the Kamuzu Central Hospital the nurse agreed that Chimwemwe's labor had just begun and sent her to a room to rest if possible and to wait indefinitely. Namaleu and Chimwemwe sent me home to sleep - an invitation I happily accepted. I returned a few hours later with porridge and bread; her cervix was 4cm dilated. Chimwemwe ate a couple cups of porridge, then her mom suggested a "jolly walk." I accompanied her to the end of the outside corridor and then was shocked when she asked me to wait a minute as she ran up and down the flight of stairs three times.
The labor progressed fairly slowly throughout the day. I watched over Chimwemwe and the baby as she visited with sisters and relatives and ate and ate. I had never before seen a woman eat like her during labor. She would only stop chewing during the contractions and then resume - gesturing to hand over her food - as soon as they passed . . . oranges, samosas, bread, rice and beef, nsima and eggs, sausage and greens, juice, water, tea. I told her she would definitely have the strength to push when that moment came.
Finally, around 5pm we moved into the labor ward. Around 7 she seemed to be stuck at 8 centimeters and the baby remained high. Her contractions never came more frequently than once every five minutes. We tried walking, squatting, standing, rocking, but her contractions did not pick up and the baby, although doing well, stopped moving down. I suggested that maybe we give her a little pitocin (a synthetic version of oxytocin - the hormone which drives the pattern and strength of contractions) but she wanted to wait. Seeing the concern on my face she told me in a calm confident tone, "Don't worry, Joanne, I'm still strong." At 8 we started the pitocin, within minutes her cervix was fully dilated, and 20 minutes later I was lifting the baby on to her belly (all that food sure helped). At that exact moment her phone rang and she shouted into it, "IT'S A BOY!!" Chimwemwe was beaming and doing a little dance in the bed; I was laughing and smiled until my cheeks hurt. No more doubts about midwifery. I LOVE this job! I'd do it for bread and water.
A few days later Chimwemwe and her family asked me to give the baby a name. The father had given the first name and I gave the second. He is now forever Precious Yankho. (Yankho means answer, as he was an answer to many prayers.)
According to a hazy memory of her last period, her due date was set sometime in June, but June came and went, early July came and went, and still the baby gave no signs that it was ready to see the world. I met Chimwemwe for the first time on July 16 and by a conservative estimate she was well into the 42nd week of the pregnancy (as the pregnancy continues past 42 weeks there is a sharp increase in the risk of stillbirth as the placenta begins to deteriorate). The following day I scanned her at Bottom and could see that the baby was active and had plenty of fluid; her cervix was soft but closed - a sign that labor was still a couple days off. We decided to meet early in the following week for another scan and possibly an induction.
On the 19th I had planned a three day trip to the lake with my friend Deb who would be leaving Malawi permanently on the 27th. I very much wanted to be present for Chimwemwe's birth but both Chim and her mom knew that I would be away for a couple days. Chimwemwe seemed confident that the baby was well and would wait for my return.
Sunday Chimwemwe had mild contractions and neither she nor her mother slept but Monday the contractions stopped. Monday night and Tuesday the pattern repeated. Tuesday night at 1:30am sister Namaleu called and said they were ready to go to the hospital. Pulling myself from my warm cozy sleep, I momentarily doubted my calling as a midwife, and only with great effort escaped the magnetism of my bed. I expected that Chimwemwe was still in early labor and wanted to talk to her or examine her before we left for the hospital, but when I reached their house she and her mother were already standing out in the cold night bundled in chitengies, bags ready at their feet. I realized later that when six girls share a bedroom and when the laboring women shares a twin bed with her younger sister, the hospital is a better option than home, even in early labor. (If I hadn't had a friend sleeping in my guest room I would have brought them to my place.)
When we arrived at the Kamuzu Central Hospital the nurse agreed that Chimwemwe's labor had just begun and sent her to a room to rest if possible and to wait indefinitely. Namaleu and Chimwemwe sent me home to sleep - an invitation I happily accepted. I returned a few hours later with porridge and bread; her cervix was 4cm dilated. Chimwemwe ate a couple cups of porridge, then her mom suggested a "jolly walk." I accompanied her to the end of the outside corridor and then was shocked when she asked me to wait a minute as she ran up and down the flight of stairs three times.
The labor progressed fairly slowly throughout the day. I watched over Chimwemwe and the baby as she visited with sisters and relatives and ate and ate. I had never before seen a woman eat like her during labor. She would only stop chewing during the contractions and then resume - gesturing to hand over her food - as soon as they passed . . . oranges, samosas, bread, rice and beef, nsima and eggs, sausage and greens, juice, water, tea. I told her she would definitely have the strength to push when that moment came.
Finally, around 5pm we moved into the labor ward. Around 7 she seemed to be stuck at 8 centimeters and the baby remained high. Her contractions never came more frequently than once every five minutes. We tried walking, squatting, standing, rocking, but her contractions did not pick up and the baby, although doing well, stopped moving down. I suggested that maybe we give her a little pitocin (a synthetic version of oxytocin - the hormone which drives the pattern and strength of contractions) but she wanted to wait. Seeing the concern on my face she told me in a calm confident tone, "Don't worry, Joanne, I'm still strong." At 8 we started the pitocin, within minutes her cervix was fully dilated, and 20 minutes later I was lifting the baby on to her belly (all that food sure helped). At that exact moment her phone rang and she shouted into it, "IT'S A BOY!!" Chimwemwe was beaming and doing a little dance in the bed; I was laughing and smiled until my cheeks hurt. No more doubts about midwifery. I LOVE this job! I'd do it for bread and water.
A few days later Chimwemwe and her family asked me to give the baby a name. The father had given the first name and I gave the second. He is now forever Precious Yankho. (Yankho means answer, as he was an answer to many prayers.)
Bursting
I was a bit horrified to see that my last entry was posted over a month ago. I'm sorry to all of you who have been following my entries and waiting for the next batch - I'm overdue. There was no pause in my life here, so I am now bursting with a month of untold stories. Let me just give you the headlines and then I'll come back with details. In the past month, I attended the delivery of a friend's first grandchild, spent three days at the lake, drove four of my closest friends to the airport and watched tearfully as they permanently departed Malawi, had US$3,800 in traveler's checks stolen from my home and cashed, got Bilharzia (a parasite that lives in the lake), visited Frank's group (now called Grace Charity Orphan Foundation) several times - and helped them start a gardening project, and bid a temporary farewell to Clement (my boyfriend) who finished his program of clinical medicine and has moved back to Zomba for the time being. I feel tired. Luckily I'm house-sitting for friends who have a wonderful cat, a comfy couch and plenty of movies - what more do you need for good R&R? hmm . . . maybe chocolate.
Sunday, July 02, 2006
Chiko
Thursday I took the day off from Bottom, the morning I enjoyed by myself, mostly reading in bed and then in the afternoon I decided to visit Chiko. Chikumbutso is the motherless baby girl of Nathan who lives in a village 50km outside of Lilongwe. About a month ago Nathan, her father, and his sister-in-law arrived at Bottom with a listless extremely dehydrated little Chiko. They said she had been having diarrhea for the past 24 hours and already her fontanel and eyes were impressively sunken. We took her to Kamuzu Central right away and after a week of IV fluids she returned to her beautiful bright self. I believed that Nathan would call if they needed milk or if anything were wrong with Chiko but Thursday I felt as though a small voice inside was telling me to go see her.
When I arrived at the house the sister-in-law handed me Chiko and weight the little bundle disturbed me a bit. The aunt said she had malaria. I tucked an electric thermometer under her arm and it shut off once it read 103 degrees Fahrenheit. I also noticed that some spots around her mouth were hypo-pigmented and then was stunned to see more spots spreading from her neck down over her chest. (Later, with the translating help of Sister Namaleu, the aunt told us the spots were vesicles and then sores and were now healing.) I told everyone that we should go the hospital immediately. So the aunt packed up and the three of us headed back to Lilongwe.
The clinical officer started treating her for sepsis immediately, ordered a malaria test, and a full blood count (FBC). The following day I returned to visit her with Sister Namaleu. Her temperature still climbed above 101 and none of the lab results were in the chart, even though blood was drawn early the previous afternoon. Sister Namaleu and I went to the lab to chase down the results; we found that Chiko’s blood was negative for malaria parasites but her hemoglobin was 7.6 (anemic) and her platelets 50 (low). On our way back to the ward we cornered the chief pediatrician who told us that he would not yet consider transfusing her but would repeat the FBC Monday.
I just returned from the hospital where I met Chiko with her pink knitted hat strapped to her aunt's back. She was smiling and cooing and looking much better. The aunt says her antibiotic injections will finish tomorrow. I'll make sure that she gets another FBC to see if there is any change and if it's no worse she'll be heading home on Tuesday.
When I arrived at the house the sister-in-law handed me Chiko and weight the little bundle disturbed me a bit. The aunt said she had malaria. I tucked an electric thermometer under her arm and it shut off once it read 103 degrees Fahrenheit. I also noticed that some spots around her mouth were hypo-pigmented and then was stunned to see more spots spreading from her neck down over her chest. (Later, with the translating help of Sister Namaleu, the aunt told us the spots were vesicles and then sores and were now healing.) I told everyone that we should go the hospital immediately. So the aunt packed up and the three of us headed back to Lilongwe.
The clinical officer started treating her for sepsis immediately, ordered a malaria test, and a full blood count (FBC). The following day I returned to visit her with Sister Namaleu. Her temperature still climbed above 101 and none of the lab results were in the chart, even though blood was drawn early the previous afternoon. Sister Namaleu and I went to the lab to chase down the results; we found that Chiko’s blood was negative for malaria parasites but her hemoglobin was 7.6 (anemic) and her platelets 50 (low). On our way back to the ward we cornered the chief pediatrician who told us that he would not yet consider transfusing her but would repeat the FBC Monday.
I just returned from the hospital where I met Chiko with her pink knitted hat strapped to her aunt's back. She was smiling and cooing and looking much better. The aunt says her antibiotic injections will finish tomorrow. I'll make sure that she gets another FBC to see if there is any change and if it's no worse she'll be heading home on Tuesday.
Ripples and Waves
Frank continues to amaze me. Frank is the young father of Grace, widowed the day after Grace’s birth. A few weeks ago Frank took me to his house for the first time, usually we meet at the mother-in-law’s house where Grace lives. Frank lives in a very modest two-room adobe home that could easily fit into my bedroom, without electricity or indoor plumbing, and he shares this space with a young male relative. I sat on one couch chair and Frank sat on another. As I listened to him talk about his good fortune, I took in our surroundings. He said he might have had to sell his bed and the mattress and his little sofa set (which he bought for 2,200MK) just to try to afford the monthly formula bill of 9,000MK to keep Grace alive. A small shelf pushed into a corning, held some bread, eggs, and a couple old newspapers. He said if it weren’t for the help of others he might be completely destitute but because of the help, his life is good. A cluster of unframed pictures of his dead wife hung on the wall across from where he sat. His own hand-written notes surrounded the pictures; notes to her, notes about how he misses her, notes about the existence of God. Whenever he talks about Grace his eyes tear up and he shakes his head, but his smile always quickly returns. He said he has changed, that before he never understood the depth of despair and could not feel compassion for those who were suffering. A thin sheet hung in the doorway between the sitting room and the bedroom; through the sheet I could see a small simple bed. Now, he said, he just wants to help others. He said his ultimate dream is to start an orphanage.
Some small ripple began with that conversation. Together we decided to start by choosing five destitute families in his area who are supporting orphaned infants, or infants of terminally ill mothers. Frank quickly identified the families and made lists of the dependents and the items he thought they needed most.
A week later we had our first meeting with the group. I held chubby gurgling 4-month-old Grace on my lap as I sat among the other women on a mat. All the children were below 2 years and none of them looked healthy. The oldest, a 16-month-old girl was still not walking or talking and weighed the same as 4-month-old Grace, 7kgs. We told the women that we would buy them basic goods once a month, and then they as a group would have to decided what they wanted to do to support each other (e.g. start a garden, raise chickens, etc). Frank and I went to the market and bought each woman a 40kg bag of maize, 12 candles, cooking oil, 2kgs of beans, formula for the two who still needed to nurse but were unable to nurse, a high protein and calorie mixture for the little girl, soap, and a soy and maize based porridge for all the children. I also distributed some donated clothing.
The following week Frank told me I needed to arrive at the house on Saturday at 9am. Frank’s mother-in-law had called a Malawian Parliamentarian (MP) who said he wanted to support our group. The MP sent a donation of many bags of pala (the enriched porridge) and canned beans and said the President’s wife would also be sending donations from time to time. The MP could not come to the group himself, so Frank’s mother-in-law asked me to come to distribute the items to the families instead. I in turn asked Sister Namaleu to come along because I knew she would be a willing and wonderful asset.
When we arrived, women and children covered the small dirt area in front of the house. A song rose spontaneously and joyfully and as they sang, each woman came up one-by-one to shake our hands. After the greetings, the women served pala to the group of 30 or more children present and then we distributed the pala and beans. Frank decided that with the continued support of the MP, the larger group of children could come to the house to eat pala twice and week and the original group of five would come three times. Our ripple fed a small stream of change and hope.
The greatest part of the morning was watching the little girl – who only one week before personified a tiny exhausted old woman – laughing, squealing, and trying to walk.
It’s stunning how so many people really need so little. And, how so little means so much in certain hands and bellies.
Some small ripple began with that conversation. Together we decided to start by choosing five destitute families in his area who are supporting orphaned infants, or infants of terminally ill mothers. Frank quickly identified the families and made lists of the dependents and the items he thought they needed most.
A week later we had our first meeting with the group. I held chubby gurgling 4-month-old Grace on my lap as I sat among the other women on a mat. All the children were below 2 years and none of them looked healthy. The oldest, a 16-month-old girl was still not walking or talking and weighed the same as 4-month-old Grace, 7kgs. We told the women that we would buy them basic goods once a month, and then they as a group would have to decided what they wanted to do to support each other (e.g. start a garden, raise chickens, etc). Frank and I went to the market and bought each woman a 40kg bag of maize, 12 candles, cooking oil, 2kgs of beans, formula for the two who still needed to nurse but were unable to nurse, a high protein and calorie mixture for the little girl, soap, and a soy and maize based porridge for all the children. I also distributed some donated clothing.
The following week Frank told me I needed to arrive at the house on Saturday at 9am. Frank’s mother-in-law had called a Malawian Parliamentarian (MP) who said he wanted to support our group. The MP sent a donation of many bags of pala (the enriched porridge) and canned beans and said the President’s wife would also be sending donations from time to time. The MP could not come to the group himself, so Frank’s mother-in-law asked me to come to distribute the items to the families instead. I in turn asked Sister Namaleu to come along because I knew she would be a willing and wonderful asset.
When we arrived, women and children covered the small dirt area in front of the house. A song rose spontaneously and joyfully and as they sang, each woman came up one-by-one to shake our hands. After the greetings, the women served pala to the group of 30 or more children present and then we distributed the pala and beans. Frank decided that with the continued support of the MP, the larger group of children could come to the house to eat pala twice and week and the original group of five would come three times. Our ripple fed a small stream of change and hope.
The greatest part of the morning was watching the little girl – who only one week before personified a tiny exhausted old woman – laughing, squealing, and trying to walk.
It’s stunning how so many people really need so little. And, how so little means so much in certain hands and bellies.
A Few Quotes on Happiness
Whatever joy there is in this world
All comes from desiring others to be happy,
And whatever suffering there is in this world
All comes from desiring myself to be happy
-- Shantideva, A Guide to the Bodhisattva’s Way of Life
If you try to subdue your selfish motives—anger and so forth—and develop kindness and compassion for others, ultimately you yourself will benefit more than you would otherwise. . . Foolish selfish people are always thinking of themselves, and the result is negative. Wise selfish people think of others, help others as much as they can, and the result is that they too receive the benefit.
-- His Holiness the Dalai Lama, A Policy of Kindness
There is some kind of ultimate justice or goodness in the universe. It is that goodness that we are all trying to uncover and to free. Whenever we act positively, we move toward it; whenever we act negatively, we obscure it and inhibit it. And whenever we cannot express it in our lives and actions, we feel miserable and frustrated.
--Sogyal Rinpoche, The Tibetan Book of Living and Dying
All comes from desiring others to be happy,
And whatever suffering there is in this world
All comes from desiring myself to be happy
-- Shantideva, A Guide to the Bodhisattva’s Way of Life
If you try to subdue your selfish motives—anger and so forth—and develop kindness and compassion for others, ultimately you yourself will benefit more than you would otherwise. . . Foolish selfish people are always thinking of themselves, and the result is negative. Wise selfish people think of others, help others as much as they can, and the result is that they too receive the benefit.
-- His Holiness the Dalai Lama, A Policy of Kindness
There is some kind of ultimate justice or goodness in the universe. It is that goodness that we are all trying to uncover and to free. Whenever we act positively, we move toward it; whenever we act negatively, we obscure it and inhibit it. And whenever we cannot express it in our lives and actions, we feel miserable and frustrated.
--Sogyal Rinpoche, The Tibetan Book of Living and Dying
Innocent
I told the beginning of Innocent’s story a while back during my first months in Malawi. He is one of many dependants of a woman who has lost 6 of her 8 adult children. With their physical departure each child left her with a few more orphans to add to her household. Innocent is 19, he’s a bright sweet kid who did well in secondary school but could not continue his education because no one was able to pay school fees. He wanted to attend a one-year computer-training course and so with some of the money I received, I paid the fees. His final exams were scheduled for May 2006. In January I went with him to the school to give them a check for the exam fees to ensure that they received the payment on time. In April he was told that he would not be able to sit the exams in May because I was supposed to pay with a bank note and since the school had to obtain the bank note themselves, the fees were not processed in time . . . grrrrr. Of course I went to the school, argued with the school administrator and director but they held firm, it wasn’t their fault that someone from the school failed to tell me this the day I handed them the check, it was Innocent’s fault because he was supposed to know and tell me. Right. Poor Innocent cried in the school office. They then told him he was supposed to take the exams in June from the 26th to the 29th.
Sunday morning, June 25th Innocent’s family called me saying that he had been arrested, had been beaten, and was being held in the main police station. Due to other unforeseen events I didn’t arrive at their house until 3:45pm at which time they told me the station would close at 4. I rushed to the station with a relative and luckily found it open. The police led us to Innocent. They were keeping him in an outside partially covered courtyard, along with two other prisoners, a man and a woman. All three of them looked haggard, cold, with bare feet, and they huddled together on a cement step (winter has arrived in Lilongwe bringing cool night temperatures of about 50 degrees F). Innocent told me that he was accused of stealing the laptop of a foreign student. (His guardian is the housemother at the dormitory of the nursing college and so she lives with her family in a small home built into the dorm.) The student reported a missing laptop and the campus security officer said someone told him that they saw Innocent leaving the building with a bag. Innocent said he did have a bag but that it just contained his books and nothing more. He said at the time of the robbery he was playing darts with friends. He told me that the police had been beating him with a gun. The remainder of my evening was spent trying to find a way to get him out.
First, we went to the arresting officer’s home, who I had been told, had the authority to release Innocent. My biased impression of him was that of a crooked little man with a Napoleon complex; he wanted me to pay him personally the price of the laptop 1,200 British pounds to release Innocent (right). I went to talk to the student, who was quite disturbed by the turn of events but when she asked the college dean what would happen if she dropped the charges, the dean replied that the school would no longer help her with the investigation, nor give her any money towards the stolen laptop. (Supposedly the school was at least partially at fault since they knew the locks on the room needed to be replaced but had not replaced them.) In the end, the student, along with the security officer, and Innocent’s guardian went to the dean’s house. They managed to agree to release him for his exams but he was supposed to return for “questioning” on Thursday. Monday morning, a relative called me to let me know they had released Innocent at 6am. He left the police station and went directly to sit for his exams. I talked to him to him Monday night he sounded sad and tired, and said, “I don’t want to go back.”
Thursday night I had dinner with a group of visiting Americans, they had invited me and a Malawian priest to join them. Our hosts introduced the priest to me as THE spokesperson of the Malawian religious community to the government. Over the course of the evening his passion shone through as he told story after story of his years of advocacy work. Just as he was about to bid everyone goodnight, I told him about Innocent and asked if he knew someone who might be able to help. He made a phone call, quickly explained the story to the person on the other end in Chichewa, and then as he handed me the phone said, “This is the former Attorney General of Malawi.” That knocked the breath out of me. The former Attorney General said he would look into it and took Innocent’s contact information. My fingers are crossed.
Sunday morning, June 25th Innocent’s family called me saying that he had been arrested, had been beaten, and was being held in the main police station. Due to other unforeseen events I didn’t arrive at their house until 3:45pm at which time they told me the station would close at 4. I rushed to the station with a relative and luckily found it open. The police led us to Innocent. They were keeping him in an outside partially covered courtyard, along with two other prisoners, a man and a woman. All three of them looked haggard, cold, with bare feet, and they huddled together on a cement step (winter has arrived in Lilongwe bringing cool night temperatures of about 50 degrees F). Innocent told me that he was accused of stealing the laptop of a foreign student. (His guardian is the housemother at the dormitory of the nursing college and so she lives with her family in a small home built into the dorm.) The student reported a missing laptop and the campus security officer said someone told him that they saw Innocent leaving the building with a bag. Innocent said he did have a bag but that it just contained his books and nothing more. He said at the time of the robbery he was playing darts with friends. He told me that the police had been beating him with a gun. The remainder of my evening was spent trying to find a way to get him out.
First, we went to the arresting officer’s home, who I had been told, had the authority to release Innocent. My biased impression of him was that of a crooked little man with a Napoleon complex; he wanted me to pay him personally the price of the laptop 1,200 British pounds to release Innocent (right). I went to talk to the student, who was quite disturbed by the turn of events but when she asked the college dean what would happen if she dropped the charges, the dean replied that the school would no longer help her with the investigation, nor give her any money towards the stolen laptop. (Supposedly the school was at least partially at fault since they knew the locks on the room needed to be replaced but had not replaced them.) In the end, the student, along with the security officer, and Innocent’s guardian went to the dean’s house. They managed to agree to release him for his exams but he was supposed to return for “questioning” on Thursday. Monday morning, a relative called me to let me know they had released Innocent at 6am. He left the police station and went directly to sit for his exams. I talked to him to him Monday night he sounded sad and tired, and said, “I don’t want to go back.”
Thursday night I had dinner with a group of visiting Americans, they had invited me and a Malawian priest to join them. Our hosts introduced the priest to me as THE spokesperson of the Malawian religious community to the government. Over the course of the evening his passion shone through as he told story after story of his years of advocacy work. Just as he was about to bid everyone goodnight, I told him about Innocent and asked if he knew someone who might be able to help. He made a phone call, quickly explained the story to the person on the other end in Chichewa, and then as he handed me the phone said, “This is the former Attorney General of Malawi.” That knocked the breath out of me. The former Attorney General said he would look into it and took Innocent’s contact information. My fingers are crossed.
Comic Relief
An acquaintance of mine recently had his laptop stolen from his house, while he was inside sleeping. The police came to investigate. As they were leaving, they turned to him and in a somber tone said, “We’ve had a recent rise in break-ins by people who can shrink themselves down to fit in-between the burglar bars.”
How can you even begin to respond to that?
How can you even begin to respond to that?
Tuesday, June 27, 2006
Grit
I’m sitting in the Embassy, it’s 10pm, quiet, and dark. I am tired, not just from the day but from the week and the month and perhaps the year. I want a vacation and I will take one sometime soon but I find it hard to reconcile my feelings of exhaustion with the realities of life faced by my friends who are nurses. I have not mentioned them yet, Beatrice Namaleu and Simbili Msiska. I met sister Namaleu (remember sister is the title for nurses here, not just nuns) months ago when I brought Gabriel to the malnutrition ward (ward C) in Kamuzu Central Hospital. I hope she doesn’t mind my telling her story here and I hope you can see the light she emits through my words.
When we came that day Sister Namaleu was the one person who smiled. She saw the dying baby and his grandmother and me, acknowledged the urgency, and helped us without extra effort on our part to plead our case. Over the time that Gabriel stayed in ward C I hear her story bit by bit and we became friends. Sister Namaleu has been working in the government hospitals for over 20 years. That is a long time to work anywhere but even longer somewhere like KCH. Because of the shortage she often works 72 hour shifts. Of course the first time she told me this I was horrified and astounded. She simply said, with her usual smile, “We are three, if one is sick and one is at a funeral, that means I am the only one,” then pausing and looking around the noisy ward filled with at least a hundred children said, “and I cannot leave these children alone.” It is incredible that she does this regularly but the true miracle is that she smiles.
Sometimes, I visit her when she’s working and if I’m not in a rush she will take me around, show me the children she is most concerned about, introduce me to mothers who cannot breastfeed or to caretakers of infant orphans. She LOVES them. Even though there are hundreds she knows them, the ones with the swollen bellies and the tiny surgical patients, and they know her.
One day as we were walking out together I noticed a severely emaciated child sitting in a bed sobbing, while several women on the floor were eating and clearly laughing at the source of his tears. As we passed he called to Sister Namaleu and with a smile, she shooed the women away and negotiated with him until he dried his tears. When we left she told me his story. He was crying because he wanted to eat nsmia the “real” food his family members were eating but because he needed more calories he was only allowed to drink a calorie rich formula. She said his stays in the ward were becoming more and more frequent, he had been HIV positive since birth and now his body, after 15 hard years, was just wearing out. She told me she would ask the doctors if he could eat a little nsima. His story is sad, but what impressed me most, was not the image of his ribs or wrists but the compassion and respect Sister Namaleu had for both the boy and his family, and the joy she expressed in every act.
At home Sister Namaleu has six daughters, ranging in age from 9 to 18. Her husband, recently employed after 16 years of unemployment, moved to Mzuzu (four hours north) because that is where he found work and lives with the eldest daughter. Sister Namaleu jokingly calls their humble house in Lilongwe a girl’s dormitory. Her family has survived on her meager salary alone for many years and she has worked for every kwacha, in September this year she will retire; she wants to return to school to get a degree (now she only has a diploma in nursing). When I asked her who I will come to and who will take care of her little ones she says, “I will still come. I will have more time to see the ones who need me most.”
Msiska is my other beloved nurse friend. Msiska works with me in the labor ward. Frankly, when we first met, she scared me. She rarely smiled and I felt as though she was constantly assessing me. She is the charge nurse for the ward. Over the past year many things happened in life and in the ward and now her face is one of those I most look forward to seeing. (That experience of transformation provided an important personal lesson.) Msiska is a great midwife. She still often looks run down but there is no doubt that she always cares. There is so much about being a midwife (especially at Bottom) that is not glamorous, sometimes I have to laugh at how much and deeply I love it. Msiska shares this love.
Sometime last year DFID (the British development agency) decided to give money specifically to increase the salaries of nurses and clinicians, the thought being that this would help with retention of health workers. Unfortunately, the government decided that the new salaries bumped everyone into a higher tax bracket and in the end, nurses took home less money. In a similarly tragic turn of good news souring, earlier this year nurses were paid arrears (I’m still not clear what this was for) but two months ago the government decided they had over paid the arrears and would recover the money by deduct a fixed some from everyone’s pay check for the next 6 months. Last month Msiska tearfully showed me her pay check. Usually she earns 21,000MK (150MK:US$1), last month she brought home 8,000MK. This amount supports Msiska, her unemployed husband, their three children, two other orphans, and her mother.
So these are the women I work with, and I complain of being tired. I know some of it is choice and circumstance but it also determination and grit. I also know I will collapse if I work the way they do. I will take the vacation my friends and loved ones assure me I deserve, but part of me just feels weak as though I lack solidarity and strength.
When we came that day Sister Namaleu was the one person who smiled. She saw the dying baby and his grandmother and me, acknowledged the urgency, and helped us without extra effort on our part to plead our case. Over the time that Gabriel stayed in ward C I hear her story bit by bit and we became friends. Sister Namaleu has been working in the government hospitals for over 20 years. That is a long time to work anywhere but even longer somewhere like KCH. Because of the shortage she often works 72 hour shifts. Of course the first time she told me this I was horrified and astounded. She simply said, with her usual smile, “We are three, if one is sick and one is at a funeral, that means I am the only one,” then pausing and looking around the noisy ward filled with at least a hundred children said, “and I cannot leave these children alone.” It is incredible that she does this regularly but the true miracle is that she smiles.
Sometimes, I visit her when she’s working and if I’m not in a rush she will take me around, show me the children she is most concerned about, introduce me to mothers who cannot breastfeed or to caretakers of infant orphans. She LOVES them. Even though there are hundreds she knows them, the ones with the swollen bellies and the tiny surgical patients, and they know her.
One day as we were walking out together I noticed a severely emaciated child sitting in a bed sobbing, while several women on the floor were eating and clearly laughing at the source of his tears. As we passed he called to Sister Namaleu and with a smile, she shooed the women away and negotiated with him until he dried his tears. When we left she told me his story. He was crying because he wanted to eat nsmia the “real” food his family members were eating but because he needed more calories he was only allowed to drink a calorie rich formula. She said his stays in the ward were becoming more and more frequent, he had been HIV positive since birth and now his body, after 15 hard years, was just wearing out. She told me she would ask the doctors if he could eat a little nsima. His story is sad, but what impressed me most, was not the image of his ribs or wrists but the compassion and respect Sister Namaleu had for both the boy and his family, and the joy she expressed in every act.
At home Sister Namaleu has six daughters, ranging in age from 9 to 18. Her husband, recently employed after 16 years of unemployment, moved to Mzuzu (four hours north) because that is where he found work and lives with the eldest daughter. Sister Namaleu jokingly calls their humble house in Lilongwe a girl’s dormitory. Her family has survived on her meager salary alone for many years and she has worked for every kwacha, in September this year she will retire; she wants to return to school to get a degree (now she only has a diploma in nursing). When I asked her who I will come to and who will take care of her little ones she says, “I will still come. I will have more time to see the ones who need me most.”
Msiska is my other beloved nurse friend. Msiska works with me in the labor ward. Frankly, when we first met, she scared me. She rarely smiled and I felt as though she was constantly assessing me. She is the charge nurse for the ward. Over the past year many things happened in life and in the ward and now her face is one of those I most look forward to seeing. (That experience of transformation provided an important personal lesson.) Msiska is a great midwife. She still often looks run down but there is no doubt that she always cares. There is so much about being a midwife (especially at Bottom) that is not glamorous, sometimes I have to laugh at how much and deeply I love it. Msiska shares this love.
Sometime last year DFID (the British development agency) decided to give money specifically to increase the salaries of nurses and clinicians, the thought being that this would help with retention of health workers. Unfortunately, the government decided that the new salaries bumped everyone into a higher tax bracket and in the end, nurses took home less money. In a similarly tragic turn of good news souring, earlier this year nurses were paid arrears (I’m still not clear what this was for) but two months ago the government decided they had over paid the arrears and would recover the money by deduct a fixed some from everyone’s pay check for the next 6 months. Last month Msiska tearfully showed me her pay check. Usually she earns 21,000MK (150MK:US$1), last month she brought home 8,000MK. This amount supports Msiska, her unemployed husband, their three children, two other orphans, and her mother.
So these are the women I work with, and I complain of being tired. I know some of it is choice and circumstance but it also determination and grit. I also know I will collapse if I work the way they do. I will take the vacation my friends and loved ones assure me I deserve, but part of me just feels weak as though I lack solidarity and strength.
Wednesday, May 31, 2006
Wednesday's Thought
Personally I feel as I age that the contrast between life's beauty and sadness only intensifies and the question "WHY?" only resounds louder. Life is a difficult place to find comfort. Maybe if I were a different person I would be depressed or maybe I would be a Buddhist nun. But here in my present, I'm moving forward with the two only truths I have discovered thus far . . . 1) life is tenacious, and 2) sad and angry people don't usually have much to offer, so if a choice must be made it's better to look for the rainbows even if they are extremely elusive.
Monday, May 22, 2006
Sweet and Sorrowful
Not many expatriates delivery in Malawi. Endemic horror stories convince most that they must escape the hospitals Malawians cannot choose to escape. Of course I intimately know many problems that plague the health care system here, but somehow I still find the alacrity of flight disturbing. I am not saying I would not leave myself if I felt the care I required was more readily available outside. I am saying it disturbs me. It seems that individual decisions to leave reveal our shallow roots. We say, "I like you but I cannot REALLY trust you." "I will work with you but I will always keep my 'get outta jail, free' card in my back pocket." The subtle message being, "we can work at becoming equals but we are not equal." A constant reminder that we are in this world but not of it. Dominique and Patricio, unlike most, decided they would stay and have their baby at Kamuzu Central Hospital.
Tarek introduced us in January. Dominque's due date was the end of March. I was thrilled with the idea of accompanying a couple through the process of pregnancy to birth and beyond, and I instantly fell in love with Dominque's calm certainty as well as with Patricio's energy and adoration for his growing family.
May 9, I met them at the hospital to give them a tour of the labor ward, several weeks before the expected arrival. But Tarek had scanned her just moments before and said the baby was not growing well, he said there was little amniotic fluid and it needed to come out soon. Tarek decided to recheck in two days.
May 11th, the story was the same. Dominique hoped for a vaginal birth and wanted to try an induction, so we began. Inductions are slow. I gave her the first dose of medication to ripen her cervix and we waited. I listened to the baby's heart. And we waited. Two hours later Tarek agreed that we could continue at my house (which is a 5 minute drive from the hospital) and so we packed up and headed there. I cooked and listened and we waited.
After four hours I gave her the second dose. Dominque said she felt well and I listened, but the baby was changing. As the silence between each beat spread, I could feel my heart filling the time with it's own accelerating rhythm. I called Tarek and we quickly agreed that the induction had failed and it was time to move to a caesarian.
Within 30 minutes Dominique was on the operating table, Mr Banda (the Malawian anesthetist) was placing her spinal, Lisa (the Australian pediatrician) was helping me assemble the resuscitation equipment, and Tarek and the scrub nurses were ready to begin. Poor Patricio was left alone in the empty hall looking incredibly anxious, sitting on the single available chair.
Within two minutes of the first incision, a little girl was wiggling in my hands. It took her a minute to pink up - Lisa and I held our breaths in subconscious solidarity - and then she did, and she was beautiful. Mr Banda was the first to give Patricio the good news. I came out a minute later to get the chitengi from Patricio and was surprised to find him talking with Clement (all the Malawian women bring a new colorful chitengi to wrap their little ones in and Dominique had done the same much to the enjoyment of the Malawian nurses). Apparently Clement called me but when I didn't answer he suspected something was happening and headed to the labor ward where he was told that we were in theatre. Patricio said he appeared like an angel, "just when I was ready to kill myself he walked through the door and took away the knife."
It was the most beautiful caesarian ever; one of the most beautiful births. After Dominique was wheeled out of the theatre, everyone who participated stood around together and took pictures as a group. There was a moment when Patricio held his baby girl looking at her with such amazing love, and Tarek and Clement were also gazing over his shoulders adoringly. That was definitely my favorite part, three men completely awestruck by a tiny little girl (2.5kg).
Dominique and Patricio stayed in the hospital Thursday and Friday and then Saturday Tarek said it would be alright if they continued their convalescence at my home. Every morning felt like Christmas - the feeling that an incredible vision was waiting; every morning waking up to see the beautiful baby. Every evening coming home felt like peace. Tuesday Tarek said they could go home and they did. Before they left, after several nameless days, they gave her a name, Lua Joanne Alvarez.
Saturday night, the night new life entered my home, I got a call, someone speaking Chichewa I could not understand. It was the same number I had seen a few time in the previous nights but I always thought it was a wrong number so I just hung up. This time I asked Clement to talk. He said it was the headman from Mbizi saying the baby died. I didn't sleep well, wondering if it was really true, realizing someone had been calling me for help and I had hung up. In the morning Ireen's father called and said her baby had indeed died, he said she didn't have enough milk to give her baby. I told him I would come. He said they would wait for me to bury the body.
I called Deb and of course she wanted to come so we headed out to the village together. When we arrived, women encircled the house and Ireen's father met our car with red eyes and tear stained cheeks. He led us to the house and the women made way for us. Inside little Alinafe was laid out on a grass mat covered by chitengies, which were pulled down for us to see her face. Ireen sat next to her on the floor ceaselessly rocking back and forth and ceaselessly crying, "Mwana anga Mwana anga" (My baby My baby). The women echoed her with their wails. Deb and I cried.
Ireen's father told us that the baby had been "crying too much in the night" and Ireen felt she didn't have enough milk. She had even told me that when I saw her last, but I saw milk in the baby's mouth as she nursed and so I just encouraged Ireen to eat well, drink much, and breastfeed often. She knew. I didn't. They had taken Alinafe to the clinic on Thursday and she died Friday.
After a short while the women placed the body in a small cloth lined box and carried it away from the circle of homes. The men walked with us until we reached the field at that point Ireen's father said he had to stay because the men couldn't go on but that we should continue with the women. Deb and I followed the procession, the last two in the line.
We followed the barefoot women through the fallow fields. I wished I was also barefoot so that the earth could absorb some of my sorrow; so that I too could feel its firmness under me and feel reassured. We walked through fields towards a conspicuous group of trees and as we walked I gathered a small handle of the purple and orange flowers that sprouted up between the drying stalks of maize.
When we entered the circle of trees, the women stopped around a small freshly dug hole. A couple women took turns digging the earth until the size and shape of the hole met their satisfaction, while others wailed. Then Deb helped them lower the small casket into the ground. Once the casket was positioned, the women climbed out, and three or four at a time, they took turns with the hoes to push the dirt back again. As they dug I tossed the flowers down, but someone recovered them and shook them free of dirt. In the end a little mound stood where the hole had been, the woman handed me the flowers, made a small pit at the head of the mound with her hand, and gestured for me to put them there. I did.
We followed the women back out to the houses again. Ireen and her parents told us we must continue to visit even though we had buried our baby. We exchanged greetings with the village headman. We promised to return and then we left.
Tarek introduced us in January. Dominque's due date was the end of March. I was thrilled with the idea of accompanying a couple through the process of pregnancy to birth and beyond, and I instantly fell in love with Dominque's calm certainty as well as with Patricio's energy and adoration for his growing family.
May 9, I met them at the hospital to give them a tour of the labor ward, several weeks before the expected arrival. But Tarek had scanned her just moments before and said the baby was not growing well, he said there was little amniotic fluid and it needed to come out soon. Tarek decided to recheck in two days.
May 11th, the story was the same. Dominique hoped for a vaginal birth and wanted to try an induction, so we began. Inductions are slow. I gave her the first dose of medication to ripen her cervix and we waited. I listened to the baby's heart. And we waited. Two hours later Tarek agreed that we could continue at my house (which is a 5 minute drive from the hospital) and so we packed up and headed there. I cooked and listened and we waited.
After four hours I gave her the second dose. Dominque said she felt well and I listened, but the baby was changing. As the silence between each beat spread, I could feel my heart filling the time with it's own accelerating rhythm. I called Tarek and we quickly agreed that the induction had failed and it was time to move to a caesarian.
Within 30 minutes Dominique was on the operating table, Mr Banda (the Malawian anesthetist) was placing her spinal, Lisa (the Australian pediatrician) was helping me assemble the resuscitation equipment, and Tarek and the scrub nurses were ready to begin. Poor Patricio was left alone in the empty hall looking incredibly anxious, sitting on the single available chair.
Within two minutes of the first incision, a little girl was wiggling in my hands. It took her a minute to pink up - Lisa and I held our breaths in subconscious solidarity - and then she did, and she was beautiful. Mr Banda was the first to give Patricio the good news. I came out a minute later to get the chitengi from Patricio and was surprised to find him talking with Clement (all the Malawian women bring a new colorful chitengi to wrap their little ones in and Dominique had done the same much to the enjoyment of the Malawian nurses). Apparently Clement called me but when I didn't answer he suspected something was happening and headed to the labor ward where he was told that we were in theatre. Patricio said he appeared like an angel, "just when I was ready to kill myself he walked through the door and took away the knife."
It was the most beautiful caesarian ever; one of the most beautiful births. After Dominique was wheeled out of the theatre, everyone who participated stood around together and took pictures as a group. There was a moment when Patricio held his baby girl looking at her with such amazing love, and Tarek and Clement were also gazing over his shoulders adoringly. That was definitely my favorite part, three men completely awestruck by a tiny little girl (2.5kg).
Dominique and Patricio stayed in the hospital Thursday and Friday and then Saturday Tarek said it would be alright if they continued their convalescence at my home. Every morning felt like Christmas - the feeling that an incredible vision was waiting; every morning waking up to see the beautiful baby. Every evening coming home felt like peace. Tuesday Tarek said they could go home and they did. Before they left, after several nameless days, they gave her a name, Lua Joanne Alvarez.
Saturday night, the night new life entered my home, I got a call, someone speaking Chichewa I could not understand. It was the same number I had seen a few time in the previous nights but I always thought it was a wrong number so I just hung up. This time I asked Clement to talk. He said it was the headman from Mbizi saying the baby died. I didn't sleep well, wondering if it was really true, realizing someone had been calling me for help and I had hung up. In the morning Ireen's father called and said her baby had indeed died, he said she didn't have enough milk to give her baby. I told him I would come. He said they would wait for me to bury the body.
I called Deb and of course she wanted to come so we headed out to the village together. When we arrived, women encircled the house and Ireen's father met our car with red eyes and tear stained cheeks. He led us to the house and the women made way for us. Inside little Alinafe was laid out on a grass mat covered by chitengies, which were pulled down for us to see her face. Ireen sat next to her on the floor ceaselessly rocking back and forth and ceaselessly crying, "Mwana anga Mwana anga" (My baby My baby). The women echoed her with their wails. Deb and I cried.
Ireen's father told us that the baby had been "crying too much in the night" and Ireen felt she didn't have enough milk. She had even told me that when I saw her last, but I saw milk in the baby's mouth as she nursed and so I just encouraged Ireen to eat well, drink much, and breastfeed often. She knew. I didn't. They had taken Alinafe to the clinic on Thursday and she died Friday.
After a short while the women placed the body in a small cloth lined box and carried it away from the circle of homes. The men walked with us until we reached the field at that point Ireen's father said he had to stay because the men couldn't go on but that we should continue with the women. Deb and I followed the procession, the last two in the line.
We followed the barefoot women through the fallow fields. I wished I was also barefoot so that the earth could absorb some of my sorrow; so that I too could feel its firmness under me and feel reassured. We walked through fields towards a conspicuous group of trees and as we walked I gathered a small handle of the purple and orange flowers that sprouted up between the drying stalks of maize.
When we entered the circle of trees, the women stopped around a small freshly dug hole. A couple women took turns digging the earth until the size and shape of the hole met their satisfaction, while others wailed. Then Deb helped them lower the small casket into the ground. Once the casket was positioned, the women climbed out, and three or four at a time, they took turns with the hoes to push the dirt back again. As they dug I tossed the flowers down, but someone recovered them and shook them free of dirt. In the end a little mound stood where the hole had been, the woman handed me the flowers, made a small pit at the head of the mound with her hand, and gestured for me to put them there. I did.
We followed the women back out to the houses again. Ireen and her parents told us we must continue to visit even though we had buried our baby. We exchanged greetings with the village headman. We promised to return and then we left.
Tuesday, May 02, 2006
Ireen
My stories weave in and out of each other, sometimes I give updates and sometimes you never hear what happens to the people I introduce you to. Ireen’s present is a happy one and her story deserves an update (March 27, 2006). Ireen is the young girl who had an unbelievable but true hemoglobin of 1.7 a couple weeks after giving birth. At the time I thought she would surely die, but 10 pints later she was smiling and packing her bags on her way back to the village. Deb and I promised to visit and we arranged a date to meet her at a nearby health center (since directions to a hut in a village off the main road are nearly unintelligible, especially when you’re getting them through a translator). Deb and I arrived at the health center as planned on a Friday to find Ireen’s father, a handsome man despite a few missing front teeth, her mother who is also stunningly beautiful but probably just passes 4 feet tall, Ireen, and the baby girl waiting.
Surprisingly her father speaks good English and as he directed us over the 20 kilometers of dirt roads back to their village he narrated the whole way. As we drove away from the main road we approached two hills that rise suddenly from the land like enormous boulders. Ireen’s father said we should remember to drive towards the hills. He told us the name of both (which I don’t remember) and that we should look for the mouth on the second hill. There is a crescent shaped crevice in the second hill that does indeed look like a soft smile. As we drove past he said in a serious tone, “It’s a very nice mouth, isn’t it?” Deb and I mumbled an agreement and stifled our laughs.
In the village, as it seems to happen in the village, we were welcomed like royalty. The father proudly introduced children and grandchildren, making each of the little ones kneel and shake our hands (that is the way children traditionally greet adults). At one point I counted over 20 children under the age of 10, all smiling and sitting calmly, dressed in literal rags (you can easily imagine the population pyramid of Malawi, no WHO graph necessary). With my paltry Chichewa I think I understood the father tell all the adults we met, including the village headman, that Ireen had run out of blood and we gave her ours (5 pints and 5 pints). We did help retrieve the blood from the bank and make sure that it went into her veins but we certainly didn’t give five pints each (I’ll have to correct that story).
Ireen looked great; I could see pink gums and a pink tongue when she laughed. We asked her if they had given her any medicine at the hospital and she said they gave her iron pills, but when it took her and her mother a good 5-10 minutes of searching to find the pills, I got the idea that she’s not taking them. The baby did not look so great; in the four hours we spent together, she just slept and slept. Finally I told Ireen to wake her and feed her, and I told her not to let her sleep so long without eating. When she did nurse, her sucking was weak, and although she grimaced she did not cry. Before we left the family fed us a meal of nsima and beans and then filled my trunk with sugar cane, green maize, and sweet potatoes.
Two weeks later, Deb and I returned. We passed the house and just as we were turning around Ireen’s father ran up breathless. He said someone told him, “Your strangers just drove by,” and so he took off after us. When we got back to the house everyone was laughing about how we just passed right by. I had worried about the baby but she was much improved, squirming, crying, nursing, acting like a normal baby. She also peed straight through my dress within my first five minutes there. This time Ireen’s father took us to his mother’s house which sat on a nearby hill (not the smiling hill) and had an amazing view. Ireen’s grandmother thanked us profusely and told us that so often when you go to the health center, the clinician just gives you a pain killer and continues to read the paper. She thanked us for taking action and saving Ireen’s life. Ireen’s great-grandmother nodded in agreement. The grandmother wanted to give us something and Ireen’s father said they would cook chicken for us next time (a big deal). Once again they served us nsima, this time with okra and pumpkin leaves (yum), and then filled my trunk sugar cane, pumpkins, and sweet potatoes. We come with so little and then end up driving away with their food. At least there is happiness on both ends. Next time I want to bring kid’s clothes, that will be fun to distribute (used clothes are cheap in the market).
Surprisingly her father speaks good English and as he directed us over the 20 kilometers of dirt roads back to their village he narrated the whole way. As we drove away from the main road we approached two hills that rise suddenly from the land like enormous boulders. Ireen’s father said we should remember to drive towards the hills. He told us the name of both (which I don’t remember) and that we should look for the mouth on the second hill. There is a crescent shaped crevice in the second hill that does indeed look like a soft smile. As we drove past he said in a serious tone, “It’s a very nice mouth, isn’t it?” Deb and I mumbled an agreement and stifled our laughs.
In the village, as it seems to happen in the village, we were welcomed like royalty. The father proudly introduced children and grandchildren, making each of the little ones kneel and shake our hands (that is the way children traditionally greet adults). At one point I counted over 20 children under the age of 10, all smiling and sitting calmly, dressed in literal rags (you can easily imagine the population pyramid of Malawi, no WHO graph necessary). With my paltry Chichewa I think I understood the father tell all the adults we met, including the village headman, that Ireen had run out of blood and we gave her ours (5 pints and 5 pints). We did help retrieve the blood from the bank and make sure that it went into her veins but we certainly didn’t give five pints each (I’ll have to correct that story).
Ireen looked great; I could see pink gums and a pink tongue when she laughed. We asked her if they had given her any medicine at the hospital and she said they gave her iron pills, but when it took her and her mother a good 5-10 minutes of searching to find the pills, I got the idea that she’s not taking them. The baby did not look so great; in the four hours we spent together, she just slept and slept. Finally I told Ireen to wake her and feed her, and I told her not to let her sleep so long without eating. When she did nurse, her sucking was weak, and although she grimaced she did not cry. Before we left the family fed us a meal of nsima and beans and then filled my trunk with sugar cane, green maize, and sweet potatoes.
Two weeks later, Deb and I returned. We passed the house and just as we were turning around Ireen’s father ran up breathless. He said someone told him, “Your strangers just drove by,” and so he took off after us. When we got back to the house everyone was laughing about how we just passed right by. I had worried about the baby but she was much improved, squirming, crying, nursing, acting like a normal baby. She also peed straight through my dress within my first five minutes there. This time Ireen’s father took us to his mother’s house which sat on a nearby hill (not the smiling hill) and had an amazing view. Ireen’s grandmother thanked us profusely and told us that so often when you go to the health center, the clinician just gives you a pain killer and continues to read the paper. She thanked us for taking action and saving Ireen’s life. Ireen’s great-grandmother nodded in agreement. The grandmother wanted to give us something and Ireen’s father said they would cook chicken for us next time (a big deal). Once again they served us nsima, this time with okra and pumpkin leaves (yum), and then filled my trunk sugar cane, pumpkins, and sweet potatoes. We come with so little and then end up driving away with their food. At least there is happiness on both ends. Next time I want to bring kid’s clothes, that will be fun to distribute (used clothes are cheap in the market).
Cromwell
For those of you who have read my earlier posts you remember Cromwell my Malawian running buddy who had a stroke at the age of 29 (see post May 30, 2005). A few months ago he left Lilongwe and moved to North to Kasungu to stay with his parents. I saw him before he left. He was both physicially and psychologically damaged. He is able to walk unassisted, but is still severly affected by the stroke and cannot use his left hand at all. He has had no physical improvement in the last many months, but I always lie and tell him he looks a bit better everytime he asks me what I think. Psychologically, well, he just seems sad.
This past weekend he came to Lilongwe for a doctor's visit and I stopped by to visit. I found him unchanged. We talked a bit and then he showed me his recent chest X-ray. It was an eerie sight. His heart fills about two-third of his chest cavity and has taken the shap of a large droopy "L". Apparently the problem is due to faulty valves; something that no one ever picked up - and even if they had, there is no heart surgeon in Malawi. So, over years and years of his heart trying to compensate for his poor valves, it has grown into an enormous disfigured muscle. I felt so sad sitting with him, looking through that window in his chest, realizing that nothing can done. Death is inevitable of course, but for him it will most likely come soon. I doubt he will reach the young life expectancy here of 37, he is 30 now.
I told him I was so sorry, he said in a sad resigned tone, "Don't worry about me, Joanne, that's part of life."
This past weekend he came to Lilongwe for a doctor's visit and I stopped by to visit. I found him unchanged. We talked a bit and then he showed me his recent chest X-ray. It was an eerie sight. His heart fills about two-third of his chest cavity and has taken the shap of a large droopy "L". Apparently the problem is due to faulty valves; something that no one ever picked up - and even if they had, there is no heart surgeon in Malawi. So, over years and years of his heart trying to compensate for his poor valves, it has grown into an enormous disfigured muscle. I felt so sad sitting with him, looking through that window in his chest, realizing that nothing can done. Death is inevitable of course, but for him it will most likely come soon. I doubt he will reach the young life expectancy here of 37, he is 30 now.
I told him I was so sorry, he said in a sad resigned tone, "Don't worry about me, Joanne, that's part of life."
Saving Lives
Last Tuesday my big dream for the Embassy came true . . . we had our first blood drive in benefit of the local hospitals and clinics. It was fabulous. I was hoping for about 20 donors and I don’t think we would have even reached that number if it had not been for Anna and Tyler Sparks who spread the word across Lilongwe and walked around USAID, CDC and the Embassy signing people up.
At the end of the day, 45 pints sat in a box, on their way to saving lives. The representative from Malawi Blood Transfusion Service (MBTS – they are the ones who collect, test, store, and distribute the blood nationwide) said it was one of their most successful drives ever. Even the US Ambassador donated and promised that he would wear his “I donated blood” sticker to Parliament.
On the whole, people were incredibly enthusiastic and many asked when the next drive would be, so they could mark it on their calendars. I was told that a large group of Peace Corps (PC)volunteers who were in town also wanted to donate but since they need individual medical clearance from the PC physician, they were unable to donate. However, the PC director did say they will organize their own drive soon. The fun part is that these are people who are not allowed to donate blood in the States because they live in a malaria endemic area.
Apparently in a meeting this morning the Ambassador raved once again about the blood drive and said that for the next drive, in September, we should involve the Germans, French, and British too. I am sooo happy.
Just as a background note, MBTS says they need about 1500 pints of blood each month to meet the demand and currently they only receive about 500. The majority of the blood is used for children (malaria induced anemia is a huge killer), for peripartum women, and trauma victims. During the rainy season, which is also the malaria season, the demand for blood increases dramatically and because there are many days when there is simply no blood available, the number of preventable deaths (especially among children) also increases. Less than a pint of blood can save the life of an anemic child! Globally, it is estimated that 43% of children under the age of 5 are anemic.
My next idea is to maintain a “food pantry” just for formula to give to the orphans of women who die in childbirth.
At the end of the day, 45 pints sat in a box, on their way to saving lives. The representative from Malawi Blood Transfusion Service (MBTS – they are the ones who collect, test, store, and distribute the blood nationwide) said it was one of their most successful drives ever. Even the US Ambassador donated and promised that he would wear his “I donated blood” sticker to Parliament.
On the whole, people were incredibly enthusiastic and many asked when the next drive would be, so they could mark it on their calendars. I was told that a large group of Peace Corps (PC)volunteers who were in town also wanted to donate but since they need individual medical clearance from the PC physician, they were unable to donate. However, the PC director did say they will organize their own drive soon. The fun part is that these are people who are not allowed to donate blood in the States because they live in a malaria endemic area.
Apparently in a meeting this morning the Ambassador raved once again about the blood drive and said that for the next drive, in September, we should involve the Germans, French, and British too. I am sooo happy.
Just as a background note, MBTS says they need about 1500 pints of blood each month to meet the demand and currently they only receive about 500. The majority of the blood is used for children (malaria induced anemia is a huge killer), for peripartum women, and trauma victims. During the rainy season, which is also the malaria season, the demand for blood increases dramatically and because there are many days when there is simply no blood available, the number of preventable deaths (especially among children) also increases. Less than a pint of blood can save the life of an anemic child! Globally, it is estimated that 43% of children under the age of 5 are anemic.
My next idea is to maintain a “food pantry” just for formula to give to the orphans of women who die in childbirth.
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