Today was my last day in the prenatal clinic and my take home thought was . . . I want to start a clinic here.
For this week I have been in the same room doing belly checks and listening to fetal heart tones. The women when they walk in the room supposedly have had their histories taken, their blood pressures taken, and have been weighed. In reality, many of the women who came to me did not have any medical history recorded in their books and some didn't even have their names written on their books. I was also a little suspicious of the blood pressures, namely because they were always nicely rounded numbers and were often the same numbers. So then, I peeked out the door and, to my horror, saw that the nurse who was taking BPs was not using a stethoscope. When I asked the nurse with me if that was their normal procedure she said that was due to short supplies, but later I found two unused stethoscopes sitting in a box in the lunch room?! Another frustrating piece is that, as far as I can tell, the nurses have tea and lunch for three to five hours each day. True, some work gets done during this period but I haven't observed much. Today for example, we saw 100 patients between 9 and 10:30 (that means each woman was in the room for about 3 minutes and 30 seconds - which includes time spent dressing and undressing). What would happen if those hours were spent providing care?
I just don't understand. In Malawi childbirth is still very dangerous, maternal mortality (per 100,000 births) is among the highest in the world, and yet the few resources that are available are not being utilized to improve care (at least not in this hospital). Leaving today I had the impression that unless the woman herself vocalizes a problem, the only thing that happens during prenatal care is that something is scribbled in her book (and often it is scribble), when it is deciferable it may not even be accurate. Therefore, when she arrives in labor, she can show that she has attended routine prenatal care, she might have 4 to 6 visits documented, but in truth she received NO care. Twins, preeclampsia, bleeding - who knows, and certainly she doesn't know what to do if she begins bleeding or seizing because no one told her about pregnancy risks.
One more story. A 41 year old woman with 7 previous pregnancies came in today saying she was pregnant because she had not had a period for three months. This early on in a pregnancy you can't necessarily palpate the uterus abdominally, and in the US, in addition to doing a pregnancy test, a midwife would size her uterus, one hand internally the other hand on her abdomen. What happened here is that the midwife told her she was going through menopause and sent her home, and then she told me "these women from the village just don't know, they can't even remember all the times they've been pregnant." What?!
Back at the College I mentioned my observation about the BPs to two Malawians who were sitting at my table in the cafeteria and one made a good suggestion. He suggested that I tell the charge nurse what I saw and simple ask (rather than accuse) "Is that the correct way to take BPs?" I think I'll try that next time I'm in that clinic, I was a little too shell-shocked to figure out how to do something diplomatically. Yesterday and today I did bring in my measuring tape and my fetoscope, I didn't say anything but I could tell the nurses were watching me measure bellies.
I am going to study hard and learn Chichewa, the faster I am able to learn the sooner I can begin talking, listening, asking, and educating.
Friday, April 22, 2005
Wednesday, April 20, 2005
A Thought
Another season of restless waiting has come to an end.
The constant pacing mind calmed by
Peace and happiness that have settled in my heart.
Women here amaze me.
So young
So small, wirey, and strong.
Walking on feet that appear to have circled the world.
Many with a baby on their back
And another growing within.
I wonder about them
And their lives.
The young ones 14, 15, 16
Stepping tentatively into this
Rush rush world of pregnancy and care.
Others of 22, 25, or 29 lifting shirts and lowering skirts
To reveal bellies marked
By the growth and birth of previous passengers.
I know these women from statistics.
These are the ones with anemia, malaria, HIV,
Living lives that would break me.
They smile at me.
Somehow trusting my hands to touch and care for them
Trusting me to care for the fragile life they carry within.
I place my hands on warm bellies
I press gently
And feel the outline of a back, a head, a bottom,
A foot kicking out resisting the pressure I create in its world.
I am here because of them,
Moms and babies.
I will do my best to ease burdens
And soften landings.
I will do my best to be worthy of their trust.
I am grateful to be in their world.
The constant pacing mind calmed by
Peace and happiness that have settled in my heart.
Women here amaze me.
So young
So small, wirey, and strong.
Walking on feet that appear to have circled the world.
Many with a baby on their back
And another growing within.
I wonder about them
And their lives.
The young ones 14, 15, 16
Stepping tentatively into this
Rush rush world of pregnancy and care.
Others of 22, 25, or 29 lifting shirts and lowering skirts
To reveal bellies marked
By the growth and birth of previous passengers.
I know these women from statistics.
These are the ones with anemia, malaria, HIV,
Living lives that would break me.
They smile at me.
Somehow trusting my hands to touch and care for them
Trusting me to care for the fragile life they carry within.
I place my hands on warm bellies
I press gently
And feel the outline of a back, a head, a bottom,
A foot kicking out resisting the pressure I create in its world.
I am here because of them,
Moms and babies.
I will do my best to ease burdens
And soften landings.
I will do my best to be worthy of their trust.
I am grateful to be in their world.
Tuesday, April 19, 2005
Orientation Begins
The Nurses and Midwives Council received enough paperwork from the States to convince them that I do indeed have a CNM license there and now I can begin the clinical part of getting my license here. I have one month of "orientation" at Bottom Hospital in different areas, an interview before a few members of the Council, and a fee to pay, and then I'll be licensed in Malawi as well. So, this week I began my orientation with antepartum (prenatal) clinic.
The particular building which houses the antepartum clinic also houses the family planning clinic, and the clinic for healthy children under 5. Before the doors open, all the women with appointments for the day (no time slots are given) gather in a covered patio area on rows of cement benches. Several hundred women sit attentively with their babies tied on their backs or nursing at their breasts, as the nurses take turns standing on the steps and giving health talks on various subjects (e.g. signs and symptoms of labor, HIV testing, family planning methods etc.). Then the session ends and the clinic day begins with a type of call and response song. Even though this is just a group of several hundred women from the community and the song is probably just a health message, their clapping and harmonizing sounds as beautiful the music of Ladysmith Black Mombaza (think Paul Simon's African infused music). I would love to record it somehow so you could hear what I mean.
Once the doors open, women are directed inside to sit on benches against certain walls depending on which clinic they will be attending. This morning the four nurses in antenatal clinic saw 150 women. Apparently they can see up to 300 in a morning. (So much for 15 minutes per visit being too short.) Women only come for prenatal care 4 times during their pregnancy. Each time they are weighed, their blood pressure taken, their belly palpated, and fetal heart tones auscultated and that's pretty much it. Depending on where they are in their pregnancy, they are given anti-malarial meds. Oh, nurses also check their tongues and inner eye lids each visit and give iron supplements depending on the shade of pink or red. There are two exam rooms - each with two tables - through which there is a constant flow of women walking-in, handing their small health history books to the nurse, climbing on the tables, uncovering their bellies, climbing down, covering bellies, scooping up children, books and pills, and exiting.
The difference between my training and this environment is stunning, to say the least, and I feel as though this is my very first week all over again, but even so, I am happy to be here. I get to lay my hands on quite a few bellies, ask women "Muli bwanji?" how are you?, "Miyezi ngathi?" how many months?, and try to hear fetal heart tones (FHTs) with the device they use. (It's called a pinard and looks like a miniature trumpet, except envision a flat piece mounted on the mouthpiece. You put the cone side to her belly and put your ear against the flat part.) I found the auscultation incredibly difficult, especially with all the ambient noise, but hopefully I'll get used to it.
I'm sure many of you wonder how the nurse can actually catch and treat problems in such short visits and, well, I'm wondering that too. Yesterday a woman with a fever (probably malaria) was sent to the lab for a blood smear but when she returned to say the lab was closed, she was prescribed medicine for malaria and pneumonia. Another woman at 24 weeks (a complete pregnancy is 40 weeks) who reported contractions, was sent to another hospital in town via public transport escorted by her husband. Both these women came with complaints and although I know the nurses must catch some problems, I'm also sure that many slip through. Especially since they don't use a measuring tape to record the growth of the belly, and since they base the date of delivery on a woman's report of how many months she is, as opposed to a recorded and well scrutinized date for her last menstrual period. Patient education also seems to be minimal, of course there are the health talks and there are posters in the halls on exclusive breastfeeding, anemia, eating iodized salt, and reporting mean nurses (I was excited to discover that I can now read these on my own - pictures help of course), but it seems like there are many gaps. At this point, inspite of my judgments, I am trying to be an observer, I am trying to learn to see as they do first, change will come later.
Yesterday and today clinic wrapped up promptly at 11 and then the nurses set out to cook their lunch. The keep a store of ofa (maize flour) in the cabinet and take turns making nsima for the group on a hot plate in one of the exam rooms (nsima, the staple food, is somewhere between the consistency of mashed potatoes and uncooked dough). Once the nsima is prepared, everyone passes around whatever they have bought from vendors outside out or brought from home (beans, chicken, french fries) and eat. Nomsa, one of the nurses, invited me to share her portion and so the two of us ate off her small plate using fingerfulls of steaming nsima to scoop up beans and chicken.
As I was typing this, a Malawian midwife came and sat at the computer next to me. She is currently getting her PhD at a university in the US but worked here many years in the hospital. She asked me about my days in the clinic and I told her about my observations and she agreed wholeheartedly with everything. Funny enough and totally unprompted, she said, "You can't imagine how I hate those songs they sing. The women sing and dance and they are happy but if you asked them what they learned they keep quiet." She said health education is lacking and even when the message is given, because of cultural dynamics, it makes no difference; the men must also hear. She also said that the midwives are used to working the way they do and are unwilling to change. They want to work half days (afternoons are used to wrap up iron tablets to be distributed the following day), they refuse to see women in the afternoon for various reasons, they say using a measuring tape to check bellies slows them down, and on and on. She said at one point the Ministry of Health even had a program for retraining midwives but none of it worked. The midwives will not lose their jobs because there is such a shortage, there is no change in pay, and so there is no motivation to change. She said, "Wait until you see the delivery ward, you will see all the problems those midwives miss . . . Sometimes you want to tell the women, 'Please have your baby at home, it is not safe here' . . . You will see, the worst is yet to come." And so I will see.
The particular building which houses the antepartum clinic also houses the family planning clinic, and the clinic for healthy children under 5. Before the doors open, all the women with appointments for the day (no time slots are given) gather in a covered patio area on rows of cement benches. Several hundred women sit attentively with their babies tied on their backs or nursing at their breasts, as the nurses take turns standing on the steps and giving health talks on various subjects (e.g. signs and symptoms of labor, HIV testing, family planning methods etc.). Then the session ends and the clinic day begins with a type of call and response song. Even though this is just a group of several hundred women from the community and the song is probably just a health message, their clapping and harmonizing sounds as beautiful the music of Ladysmith Black Mombaza (think Paul Simon's African infused music). I would love to record it somehow so you could hear what I mean.
Once the doors open, women are directed inside to sit on benches against certain walls depending on which clinic they will be attending. This morning the four nurses in antenatal clinic saw 150 women. Apparently they can see up to 300 in a morning. (So much for 15 minutes per visit being too short.) Women only come for prenatal care 4 times during their pregnancy. Each time they are weighed, their blood pressure taken, their belly palpated, and fetal heart tones auscultated and that's pretty much it. Depending on where they are in their pregnancy, they are given anti-malarial meds. Oh, nurses also check their tongues and inner eye lids each visit and give iron supplements depending on the shade of pink or red. There are two exam rooms - each with two tables - through which there is a constant flow of women walking-in, handing their small health history books to the nurse, climbing on the tables, uncovering their bellies, climbing down, covering bellies, scooping up children, books and pills, and exiting.
The difference between my training and this environment is stunning, to say the least, and I feel as though this is my very first week all over again, but even so, I am happy to be here. I get to lay my hands on quite a few bellies, ask women "Muli bwanji?" how are you?, "Miyezi ngathi?" how many months?, and try to hear fetal heart tones (FHTs) with the device they use. (It's called a pinard and looks like a miniature trumpet, except envision a flat piece mounted on the mouthpiece. You put the cone side to her belly and put your ear against the flat part.) I found the auscultation incredibly difficult, especially with all the ambient noise, but hopefully I'll get used to it.
I'm sure many of you wonder how the nurse can actually catch and treat problems in such short visits and, well, I'm wondering that too. Yesterday a woman with a fever (probably malaria) was sent to the lab for a blood smear but when she returned to say the lab was closed, she was prescribed medicine for malaria and pneumonia. Another woman at 24 weeks (a complete pregnancy is 40 weeks) who reported contractions, was sent to another hospital in town via public transport escorted by her husband. Both these women came with complaints and although I know the nurses must catch some problems, I'm also sure that many slip through. Especially since they don't use a measuring tape to record the growth of the belly, and since they base the date of delivery on a woman's report of how many months she is, as opposed to a recorded and well scrutinized date for her last menstrual period. Patient education also seems to be minimal, of course there are the health talks and there are posters in the halls on exclusive breastfeeding, anemia, eating iodized salt, and reporting mean nurses (I was excited to discover that I can now read these on my own - pictures help of course), but it seems like there are many gaps. At this point, inspite of my judgments, I am trying to be an observer, I am trying to learn to see as they do first, change will come later.
Yesterday and today clinic wrapped up promptly at 11 and then the nurses set out to cook their lunch. The keep a store of ofa (maize flour) in the cabinet and take turns making nsima for the group on a hot plate in one of the exam rooms (nsima, the staple food, is somewhere between the consistency of mashed potatoes and uncooked dough). Once the nsima is prepared, everyone passes around whatever they have bought from vendors outside out or brought from home (beans, chicken, french fries) and eat. Nomsa, one of the nurses, invited me to share her portion and so the two of us ate off her small plate using fingerfulls of steaming nsima to scoop up beans and chicken.
As I was typing this, a Malawian midwife came and sat at the computer next to me. She is currently getting her PhD at a university in the US but worked here many years in the hospital. She asked me about my days in the clinic and I told her about my observations and she agreed wholeheartedly with everything. Funny enough and totally unprompted, she said, "You can't imagine how I hate those songs they sing. The women sing and dance and they are happy but if you asked them what they learned they keep quiet." She said health education is lacking and even when the message is given, because of cultural dynamics, it makes no difference; the men must also hear. She also said that the midwives are used to working the way they do and are unwilling to change. They want to work half days (afternoons are used to wrap up iron tablets to be distributed the following day), they refuse to see women in the afternoon for various reasons, they say using a measuring tape to check bellies slows them down, and on and on. She said at one point the Ministry of Health even had a program for retraining midwives but none of it worked. The midwives will not lose their jobs because there is such a shortage, there is no change in pay, and so there is no motivation to change. She said, "Wait until you see the delivery ward, you will see all the problems those midwives miss . . . Sometimes you want to tell the women, 'Please have your baby at home, it is not safe here' . . . You will see, the worst is yet to come." And so I will see.
Monday, April 11, 2005
Phone Number
I have a cell phone, at last. The number (dialing from the US) is: 011-265-852-5951. I put a link "call Malawi" to cheap phone cards (looks like "Just India" has the best rate $0.07/min). I am 9 hours ahead of california time, 7 hours ahead of Texas time, and 6 hours of East Coast time. There is no answering message on the phone, so if you manage to get a ring, just let it ring for a while.
Best times to catch me...
weekdays: 5am-7am or 9pm-11pm
weekends: anytime 5am-11pm, but early or late may be better.
Best times to catch me...
weekdays: 5am-7am or 9pm-11pm
weekends: anytime 5am-11pm, but early or late may be better.
Thursday, April 07, 2005
1st glimpse of the Bottom
Yesterday, day 13 here in Malawi, I had my first glimpse of Bottom Hospital. I did not run away screaming but I am glad that I spent time at La Maternidad in Bolivia, and that so many people warned me about the conditions before hand. After I returned, Dr. Kaponda told me that she once took an American midwife there - who like myself intended to volunteer - but that evening, a Tuesday, she developed a headache and by Thursday she was on the plane back to the States. I’m sticking it out this week, we’ll talk later about next week : ).
Really, it is a place you must see to understand, perhaps once I’m a familiar face around the joint I’ll bring my camera and put pictures here but that will be later. The hospital itself is surprisingly small, considering it is the principal hospital for the entire central region. It actually consists of a cluster of buildings in various states of disrepair. There are male and female tuberculosis wards and male and female psychiatric wards (these wards are really just a simple one room building with about 20 or 30 beds), a small antenatal clinic, a voluntary HIV testing and counseling clinic (VIC), a polio clinic, and the maternity ward (including inpatient antenatal, an admission room, labor and delivery, postpartum, a kangaroo care room, neonatal, and the operating theatre (I love that term)).
Yesterday, apparently was a slow day for L&D, only six or seven women were in active labor when we walked in, two in second stage (pushing). The nurse greeted me, stepped aside to catch a baby and then returned to lead my tour. L&D itself is small, the size of a standard classroom. The room is painted in turquoise and old matching turquoise curtains hang between the beds, unfortunately not concealing much of anything. Each of the naked women on the bare plastic mattresses glanced up to catch my gaze as I passed through. A nurses’ station - consisting of a wooden bench, two sinks, a small refrigerator with emergency medications, and a cabinet (mostly empty) with delivery packs - divides the room, separating high risk from low risk laboring women. Near the nurses station sits the infamous broken suction machine, as well as two carts for newborns. Only one cart had a heat lamp, which did not seem to be on or working at the time we passed through, but warm or not, its small passenger was contentedly sucking on a fist.
The most impressive part, to me, were the large handwritten signs posted about the room on HIV transmission prevention, steps for managing postpartum hemorrhage, and the importance of hand-washing. Regardless of resources, it’s good to know that those are all priorities for staff. The staff I saw around the place were friendly to me and seemed to be kind to the women they were caring for (a good distinction between Bottom and La Materindad). Dr. Magete was also present and wanted to make sure I saw the suction machine.
Outside, people in bright clothes sitting on mats, or dirt, in spots of shade filled the grounds, eating, sleeping, talking, waiting. These, I was told, were the “guardians” of the patients. They stay to care for their hospitalized family members and to prepare their food in the outdoor communal kitchen located behind the psych ward. I believe the large presence of guardians exemplifies both the cultural importance placed on family as well as the nursing shortage.
My walk through lasted about an hour. I was supposed to return today for observation but we received a letter this morning from the hospital saying that they wanted something from the nurses and midwives council (NMC) before I begin observation. Unfortunately when we went to the NMC we received only a verbal “ok” so now I am here in the office again this afternoon. Paperwork paperwork blah. I suppose the good bit is that I’m sure doing a lot of journaling and those of you who are following probably know more detail about my day to day life than you ever imagined you would (I’m not sure if that’s good or burdensome for you).
Last night I went running with the expat Wednesday night running group. They are intense runners. It was work. The route was only about 6K, but it was on a dirt trail through the bush and in spite the terrain the leaders must have been going at a 7min/mi pace. It involved crossing a few muddy streams, running up hill for a long ways then down, beating through 6 ft high grass, and racing between rows of corn. If I hadn’t been thinking that I was near death for the entire run, it would have been really enjoyable. The sun was setting over the hill and there were flowers scattered among the corn, every now and then we would come upon some Malawians who would stop their work to smile and laugh at the m’zugus (white folk), and the children we passed stuck out their little hands in a line to be slapped as we ran by. I’ll do it again. I’ll look forward to getting in shape so I can keep up with the 40 and 50 year olds in the group (no joke). Only once we were all done did someone mention to me that there are venomous spitting snakes and pythons out there. Great. I’ll still do it again. I won’t be the leader so I figure I’ll be safe.
The expats, as a group, were really nice. I was among the youngest and definitely the newest arrival. I have to say that it felt really good to say, when people asked if I was visiting, “No, I just moved here.” I’m looking forward to developing community. In the group, I found a Brazilian who was so excited to speak Portuguese and already has planned outings for us, and a British woman who may have paying work for me down the line. Jennifer, the American nurse, dropped me off at home around 8. I was happy, happy for all the experiences of the day, for the potential of new friends, and the homey scene that greeted me when I returned – four women in the kitchen cooking, speaking Chichewa, and laughing.
Life is rich.
Really, it is a place you must see to understand, perhaps once I’m a familiar face around the joint I’ll bring my camera and put pictures here but that will be later. The hospital itself is surprisingly small, considering it is the principal hospital for the entire central region. It actually consists of a cluster of buildings in various states of disrepair. There are male and female tuberculosis wards and male and female psychiatric wards (these wards are really just a simple one room building with about 20 or 30 beds), a small antenatal clinic, a voluntary HIV testing and counseling clinic (VIC), a polio clinic, and the maternity ward (including inpatient antenatal, an admission room, labor and delivery, postpartum, a kangaroo care room, neonatal, and the operating theatre (I love that term)).
Yesterday, apparently was a slow day for L&D, only six or seven women were in active labor when we walked in, two in second stage (pushing). The nurse greeted me, stepped aside to catch a baby and then returned to lead my tour. L&D itself is small, the size of a standard classroom. The room is painted in turquoise and old matching turquoise curtains hang between the beds, unfortunately not concealing much of anything. Each of the naked women on the bare plastic mattresses glanced up to catch my gaze as I passed through. A nurses’ station - consisting of a wooden bench, two sinks, a small refrigerator with emergency medications, and a cabinet (mostly empty) with delivery packs - divides the room, separating high risk from low risk laboring women. Near the nurses station sits the infamous broken suction machine, as well as two carts for newborns. Only one cart had a heat lamp, which did not seem to be on or working at the time we passed through, but warm or not, its small passenger was contentedly sucking on a fist.
The most impressive part, to me, were the large handwritten signs posted about the room on HIV transmission prevention, steps for managing postpartum hemorrhage, and the importance of hand-washing. Regardless of resources, it’s good to know that those are all priorities for staff. The staff I saw around the place were friendly to me and seemed to be kind to the women they were caring for (a good distinction between Bottom and La Materindad). Dr. Magete was also present and wanted to make sure I saw the suction machine.
Outside, people in bright clothes sitting on mats, or dirt, in spots of shade filled the grounds, eating, sleeping, talking, waiting. These, I was told, were the “guardians” of the patients. They stay to care for their hospitalized family members and to prepare their food in the outdoor communal kitchen located behind the psych ward. I believe the large presence of guardians exemplifies both the cultural importance placed on family as well as the nursing shortage.
My walk through lasted about an hour. I was supposed to return today for observation but we received a letter this morning from the hospital saying that they wanted something from the nurses and midwives council (NMC) before I begin observation. Unfortunately when we went to the NMC we received only a verbal “ok” so now I am here in the office again this afternoon. Paperwork paperwork blah. I suppose the good bit is that I’m sure doing a lot of journaling and those of you who are following probably know more detail about my day to day life than you ever imagined you would (I’m not sure if that’s good or burdensome for you).
Last night I went running with the expat Wednesday night running group. They are intense runners. It was work. The route was only about 6K, but it was on a dirt trail through the bush and in spite the terrain the leaders must have been going at a 7min/mi pace. It involved crossing a few muddy streams, running up hill for a long ways then down, beating through 6 ft high grass, and racing between rows of corn. If I hadn’t been thinking that I was near death for the entire run, it would have been really enjoyable. The sun was setting over the hill and there were flowers scattered among the corn, every now and then we would come upon some Malawians who would stop their work to smile and laugh at the m’zugus (white folk), and the children we passed stuck out their little hands in a line to be slapped as we ran by. I’ll do it again. I’ll look forward to getting in shape so I can keep up with the 40 and 50 year olds in the group (no joke). Only once we were all done did someone mention to me that there are venomous spitting snakes and pythons out there. Great. I’ll still do it again. I won’t be the leader so I figure I’ll be safe.
The expats, as a group, were really nice. I was among the youngest and definitely the newest arrival. I have to say that it felt really good to say, when people asked if I was visiting, “No, I just moved here.” I’m looking forward to developing community. In the group, I found a Brazilian who was so excited to speak Portuguese and already has planned outings for us, and a British woman who may have paying work for me down the line. Jennifer, the American nurse, dropped me off at home around 8. I was happy, happy for all the experiences of the day, for the potential of new friends, and the homey scene that greeted me when I returned – four women in the kitchen cooking, speaking Chichewa, and laughing.
Life is rich.
Tuesday, April 05, 2005
Amazing People
Perhaps the mere fact that life in extreme environments demands more, foments the development of amazing individuals but whatever the reason, they are certainly here.
First off, I just want to say that Dr. Chrissie Kaponda and her husband Alex are truly incredible. The more I learn of them, the more I am blown away by their perspective, their generosity, and their work. In addition to their professional work, they have a personal commitment to educate as many girls as possible. They know that when women are educated the entire family is better off and here, in this strongly patriarchical society, there are enumerable barriers against the education of girls.
Just to provide a small cultural illustration, women when greeting men actually kneel while shaking hands (this doesn't happen often in town but I have seen it here and it seemed to be standard in the village). Women are also expected to maintain the home, cooking and cleaning for the family. So, while the boys have time to study, girls only study if and when all their other work is complete. Girls' boarding schools have come into being with the purpose of removing the brightest from their homes so they can study. One woman here told me that all professional Malawian women attended boarding schools, so this strategy seems to be working.
I'm not sure how many girls Dr. Kaponda and her husband have put through school. Alex says their have been more failures than successes, but there have been successes and at the moment they have three adolescent women, in addition to their own daughter, who are living with them and studying.
Amazing person #3. This morning I was introduced to Dr. Meguid, a visiting obstetrician who supplements the manpower of the country’s three obstetricians (yes 3). He is a tall man in his mid-40s with sincere eyes and a head full of thick shaggy brown hair. He currently works both at Bottom Hospital as well as at a private hospital. Dr. Kaponda was having a meeting with Dr. Meguid and she called me in to hear the stories he was telling.
He said that yesterday he was called to the private hospital to do a vacuum extraction. Once he arrived and assessed the situation, he determined that an episiotomy would be needed. After requesting scissors, he said it took about 5 minutes for a pair to be located, and then (remember this is at the private hospital where patients pay for care) they were so dull it took eight cuts to cut through the skin. He said to me, "I tortured the woman and she said, 'Thank you,' having no concept that she should expect better care, I felt horrible." From there, he went on to discuss the shortage of gloves. Apparently for the 30-50 deliveries done at Bottom each day, they estimate that they need 600 gloves, but Dr. Meguid said he cannot remember a day when they had enough. He also said that recently the suction in L&D broke and so now when a newborn really needs suctioning, they have to run across the hospital with the baby to the neonatal nursery.
Dr. Meguid, Dr. Kaponda, and the dean of the College were discussing the disempowerment of women here and how this directly effects high mortality rates among women and infants. He said, "They are poor, uneducated, voiceless, and have no one to speak on their behalf." No one seemed to know why basic supplies are in such short supply - mismanagement, corruption, national poverty are possibilities – but irrespective of the cause, the problem is clearly enormous.
After the horror stories, Dr. Meguid assured me that beautiful things also transpire in the hospital and welcomed me to Malawi and to this work. I was very happy to meet him and to know that he is also here, in this system, passionately envisioning and working, against all odds, towards a better reality.
If anyone does want to ship supplies here, the address is:
Dr. Chrissie Kaponda
Kamuzu College of Nursing - Research Center
Private Bag 1
Lilongwe, Malawi
Africa
(I have been told that writing "feminine hygiene products" or "religious items" on the customs slip will expedite the process.)
First off, I just want to say that Dr. Chrissie Kaponda and her husband Alex are truly incredible. The more I learn of them, the more I am blown away by their perspective, their generosity, and their work. In addition to their professional work, they have a personal commitment to educate as many girls as possible. They know that when women are educated the entire family is better off and here, in this strongly patriarchical society, there are enumerable barriers against the education of girls.
Just to provide a small cultural illustration, women when greeting men actually kneel while shaking hands (this doesn't happen often in town but I have seen it here and it seemed to be standard in the village). Women are also expected to maintain the home, cooking and cleaning for the family. So, while the boys have time to study, girls only study if and when all their other work is complete. Girls' boarding schools have come into being with the purpose of removing the brightest from their homes so they can study. One woman here told me that all professional Malawian women attended boarding schools, so this strategy seems to be working.
I'm not sure how many girls Dr. Kaponda and her husband have put through school. Alex says their have been more failures than successes, but there have been successes and at the moment they have three adolescent women, in addition to their own daughter, who are living with them and studying.
Amazing person #3. This morning I was introduced to Dr. Meguid, a visiting obstetrician who supplements the manpower of the country’s three obstetricians (yes 3). He is a tall man in his mid-40s with sincere eyes and a head full of thick shaggy brown hair. He currently works both at Bottom Hospital as well as at a private hospital. Dr. Kaponda was having a meeting with Dr. Meguid and she called me in to hear the stories he was telling.
He said that yesterday he was called to the private hospital to do a vacuum extraction. Once he arrived and assessed the situation, he determined that an episiotomy would be needed. After requesting scissors, he said it took about 5 minutes for a pair to be located, and then (remember this is at the private hospital where patients pay for care) they were so dull it took eight cuts to cut through the skin. He said to me, "I tortured the woman and she said, 'Thank you,' having no concept that she should expect better care, I felt horrible." From there, he went on to discuss the shortage of gloves. Apparently for the 30-50 deliveries done at Bottom each day, they estimate that they need 600 gloves, but Dr. Meguid said he cannot remember a day when they had enough. He also said that recently the suction in L&D broke and so now when a newborn really needs suctioning, they have to run across the hospital with the baby to the neonatal nursery.
Dr. Meguid, Dr. Kaponda, and the dean of the College were discussing the disempowerment of women here and how this directly effects high mortality rates among women and infants. He said, "They are poor, uneducated, voiceless, and have no one to speak on their behalf." No one seemed to know why basic supplies are in such short supply - mismanagement, corruption, national poverty are possibilities – but irrespective of the cause, the problem is clearly enormous.
After the horror stories, Dr. Meguid assured me that beautiful things also transpire in the hospital and welcomed me to Malawi and to this work. I was very happy to meet him and to know that he is also here, in this system, passionately envisioning and working, against all odds, towards a better reality.
If anyone does want to ship supplies here, the address is:
Dr. Chrissie Kaponda
Kamuzu College of Nursing - Research Center
Private Bag 1
Lilongwe, Malawi
Africa
(I have been told that writing "feminine hygiene products" or "religious items" on the customs slip will expedite the process.)
Monday, April 04, 2005
Week 1
Well, I'm off to a slow start but so far so good.
Friday my heart was fed. Kids are the greatest. First they stand around looking at you like you're some kind of circus freak, giggling timidly and then before you know it you're sharing a chair with a 9-year-old and have a 4-year-old in your lap happily swinging her legs. I went along with Dr. Kaponda and some other folks from the nursing college for a "graduation ceremony" for Mzake ndi Mzake (friend to friend) in a village. Mzake ndi Mzake is a program which certifies men and women living in rural areas in HIV/AIDS peer education. I didn't understand much of the ceremony just a few words here and there - "zikomo kwambiri" (thank you very much), "manja manja" (applause applause), etc. - but, it was just great to get out of the city and be there. The kids were the highlight, they tried out their English on me and laughed as I tried my Chichewa, but there was also a group of women who sang and danced during the ceremony who were wonderful to see.
Apart from that, my week was filled with Chichewa lessons and bureaucracy. My Chichewa is coming along (slow according to me, but well enough according to everyone else). At least I'm picking out words and, with the English people throw in, I sometimes can get the gest of the conversation. People speak Chichewa like people on the border speak Spanglish, okay maybe a little less English but you get the idea. The other part, the bureaucratic part, involved figuring out what hoops I need to jump through to get certified as an RN/CNM here and meeting everyone I may ever need to know or who may need or want to know me. The meetings went well, everyone is really so nice, but everyone, when I told them what I would be doing (volunteering at Bottom Hospital), had the same reaction more or less. Basically, I was told that it is a wretched place where no one would willingly enter for care, that I will be shocked, and that I need a should to cry on, hmm sounds great. Unfortunately, on the other side of things, I found as I imagined I would, that I have a bunch of paperwork that needs to be mailed, faxed, stamped, signed, etc. before I can start actually working. I'm supposed to begin orienting/observing at the hospital tomorrow. I'm not exactly sure how "observing only" will work, if the nursing shortage truly is horrendous and I see things I can do, I'm not sure how I'll just stand by. I'll have to talk that over with Dr. Kaponda.
Life at Dr. Kaponda's continues to go well. As a side note, she was incredibly appreciative of all the supplies that I brought and assured me that they will be put to good use. It's amazing and kind of frightening how excited she was about simple supplies like pen lights and BP cuffs. Thank you everyone who contributed. I still have money to donate so Dr. Kaponda suggested using it to buy cloth to sew hats and blankets for the newborns. Apparently newborns often die of hypothermia because the mother only comes with one cloth (really the clothing she wares over her skirt) and babies are dried and wrapped after birth with this one cloth.
For me so far everything has been so easy that I can forget where I am at times. Every now and then a particular sight will pull me back to reality, like the street near the nursing college which is lined, both sides, with makeshift kiosks for people making and selling coffins. Or like Saturday, when I was driving with the former dean of the college we passed a group of nursing students walking with signs through the streets. Apparently the wards at the hospital are never cleaned so the students were walking to raise money for soap and mops and brooms so that they themselves could clean the pediatrics ward. I realize there are so many levels that I am blind to now but that will be visible in time.
On the other end of the spectrum, I just met Jennifer, another American nurse-practitioner who is living and working here. She gave me a little peak into expat life here and, most importantly, she offered her shoulder if/when I need it. She is working on a capacity building project related to HIV/AIDS. In short, nurses are being brought to Lilongwe from all over, for training so they can distribute anti-retro virals (ARVs) at their home sites and disseminate info and Jennifer is trying to determine if they are actually retaining the info from the trainings. As for the expat life apparently there's tons to do. A running group meets three times a week, there's yoga daily, dinners, and a free weekly movie at the embassy (since there are no theatres in Lilongwe). She also said there is incredible nature stuff to do outside the city - great hiking, the lake is 1 and 1/2 hrs from here, and there are mountains, waterfalls, etc. This is all good. Hopefully, even though I don't have a car, I'll find a way to get to and from some of it. The other piece that she mentioned is all the development work that goes on here. It sounds like, down the line, after I establish myself and get some good experience, I may be able to find some organization that would actually pay me to do something here. So that's good too.
I think that's it for today. Thank you everyone who has been responding to me, it is always good to read your notes.
Love,
J.
Friday my heart was fed. Kids are the greatest. First they stand around looking at you like you're some kind of circus freak, giggling timidly and then before you know it you're sharing a chair with a 9-year-old and have a 4-year-old in your lap happily swinging her legs. I went along with Dr. Kaponda and some other folks from the nursing college for a "graduation ceremony" for Mzake ndi Mzake (friend to friend) in a village. Mzake ndi Mzake is a program which certifies men and women living in rural areas in HIV/AIDS peer education. I didn't understand much of the ceremony just a few words here and there - "zikomo kwambiri" (thank you very much), "manja manja" (applause applause), etc. - but, it was just great to get out of the city and be there. The kids were the highlight, they tried out their English on me and laughed as I tried my Chichewa, but there was also a group of women who sang and danced during the ceremony who were wonderful to see.
Apart from that, my week was filled with Chichewa lessons and bureaucracy. My Chichewa is coming along (slow according to me, but well enough according to everyone else). At least I'm picking out words and, with the English people throw in, I sometimes can get the gest of the conversation. People speak Chichewa like people on the border speak Spanglish, okay maybe a little less English but you get the idea. The other part, the bureaucratic part, involved figuring out what hoops I need to jump through to get certified as an RN/CNM here and meeting everyone I may ever need to know or who may need or want to know me. The meetings went well, everyone is really so nice, but everyone, when I told them what I would be doing (volunteering at Bottom Hospital), had the same reaction more or less. Basically, I was told that it is a wretched place where no one would willingly enter for care, that I will be shocked, and that I need a should to cry on, hmm sounds great. Unfortunately, on the other side of things, I found as I imagined I would, that I have a bunch of paperwork that needs to be mailed, faxed, stamped, signed, etc. before I can start actually working. I'm supposed to begin orienting/observing at the hospital tomorrow. I'm not exactly sure how "observing only" will work, if the nursing shortage truly is horrendous and I see things I can do, I'm not sure how I'll just stand by. I'll have to talk that over with Dr. Kaponda.
Life at Dr. Kaponda's continues to go well. As a side note, she was incredibly appreciative of all the supplies that I brought and assured me that they will be put to good use. It's amazing and kind of frightening how excited she was about simple supplies like pen lights and BP cuffs. Thank you everyone who contributed. I still have money to donate so Dr. Kaponda suggested using it to buy cloth to sew hats and blankets for the newborns. Apparently newborns often die of hypothermia because the mother only comes with one cloth (really the clothing she wares over her skirt) and babies are dried and wrapped after birth with this one cloth.
For me so far everything has been so easy that I can forget where I am at times. Every now and then a particular sight will pull me back to reality, like the street near the nursing college which is lined, both sides, with makeshift kiosks for people making and selling coffins. Or like Saturday, when I was driving with the former dean of the college we passed a group of nursing students walking with signs through the streets. Apparently the wards at the hospital are never cleaned so the students were walking to raise money for soap and mops and brooms so that they themselves could clean the pediatrics ward. I realize there are so many levels that I am blind to now but that will be visible in time.
On the other end of the spectrum, I just met Jennifer, another American nurse-practitioner who is living and working here. She gave me a little peak into expat life here and, most importantly, she offered her shoulder if/when I need it. She is working on a capacity building project related to HIV/AIDS. In short, nurses are being brought to Lilongwe from all over, for training so they can distribute anti-retro virals (ARVs) at their home sites and disseminate info and Jennifer is trying to determine if they are actually retaining the info from the trainings. As for the expat life apparently there's tons to do. A running group meets three times a week, there's yoga daily, dinners, and a free weekly movie at the embassy (since there are no theatres in Lilongwe). She also said there is incredible nature stuff to do outside the city - great hiking, the lake is 1 and 1/2 hrs from here, and there are mountains, waterfalls, etc. This is all good. Hopefully, even though I don't have a car, I'll find a way to get to and from some of it. The other piece that she mentioned is all the development work that goes on here. It sounds like, down the line, after I establish myself and get some good experience, I may be able to find some organization that would actually pay me to do something here. So that's good too.
I think that's it for today. Thank you everyone who has been responding to me, it is always good to read your notes.
Love,
J.
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