Proud of the wheelbed

July 30, 2012

One of the patients on home-based palliative care lacked a way to be outside her small house (hut). She loves to talk, but is not comfortable sitting up. We tried a regular wheelchair to see if she could tolerate sitting, but it was not comfortable for her. The community health volunteer, the home-based palliative care nurse, the patient and the family agreed that it would be nice to have a wheelchair that reclined like a bed. The community health volunteer put the wheelchair on the back of his bike, and took it to the local welder. Together, they made a plan for modification that would allow the patient to recline in the chair. I met with the volunteer and the welders after they had come up with a plan to negotiate a price for the materials and work. With the agreement made, the work was done quickly. In one week, the wheelchair was transformed into a “wheelbed”.

Last Friday, we picked up the wheelbed from the welders and took it to the patient. She was very comfortable in it, and pleased that she could be outside with the people in her village. The people in the village had made a ramp in anticipation of the wheelbed – but the door needs to be wider for it to get into the house. They said they would work on that this week.

I received this text message from Mr. Mgabe, the community health volunteer, about a half hour after we left the patient’s house.

“[patient] said that she is proud of the wheelbed other than her bed as you know she like chatting too much”

Although the English is not perfect, the message is clear. It has been a long time since I have heard someone say they are proud of their wheelbed, or wheelchair. I would like to hear it more often!

You can listen to Mr. Mgabe explain the wheelbed:

Wheelbed with the welder and community health volunteers

A closer view

The wheelbed being delivered to the patient’s home

Getting the wheelbed ready for the patient to try

A ramp into the patient’s home

The patient’s door that will be widened


Chewa traditions

July 29, 2012

A Nyau is part of the Chewa traditional culture. Nyau are young men from a village who dress up and participate in funerals, other traditional rituals and village ceremonies. They are typically dressed to represent an animal. It was explained to me that they are self-selected for this role in the village.

The Nyau carry the dead into the forest where Malawians have graveyards. They are the ones that can enter the graveyard areas where there might be evil spirits. Children are very afraid of Nyau because of their association with evil spirits.

Typically, the Nyau dancers are aggressive, loud, and rambunctious. They expect to be paid if you take their picture, and often have a “handler” that collects the fees. I have been told that they target the children because the children are afraid of them – and won’t really harm anyone, particularly if you are not afraid of them. When there is a Nyau in a village, the children run to their huts.

I was once approached (he was jumping around, shouting, waving a machete) by a Nyau asking for money on an isolated path far outside of the village on one of my runs. I simply said, “ I have no money” and went on my way without any trouble!

The following are some pictures and a series of short video clips of some of the Nyaus I have seen in the past few years. Some of the pictures and video are from a huge celebration where the region was welcoming a new chief. Some of the other clips are Nyaus that were in the neighboring village because of a death at the hospital, and Nyaus that were in a village for a funeral where we were visiting a patient’s family. Those pictures and video include the Nyaus, Alex (the home-based palliative care nurse), Chapunda (the driver) and the Rice students.

Two Nyaus in a village who were part of a funeral nearby

A Nyau and the Rice University students

Nyaus at a ceremony for a new chief

A Nyau at a ceremony for a new chief – depicting a horse

Nyaus dressed as colorful chickens

A Nyau….monkey


July 25, 2012

The home-based palliative care program at St. Gabriel’s relies on people in the community who care for the patients in the village.

These “community health workers” are volunteers –

volunteers who attend regular meetings and training,
volunteers who travel hours to visit patients regularly,
volunteers who care for patients and families through difficult times,
volunteers who are the link between the patient and the hospital,
volunteers that are committed to their work, unlike anything I have ever seen.

Alex and I set out to visit a patient in the village, and were met by Mgabe, the volunteer. He took charge of the project to try to modify a standard wheelchair for the patient. The patient needed to be able to recline in the chair for her comfort. Mgabe suggested that he speak to the welder in the nearest trading center and come up with a plan to make a wheelchair bed for the patient. We did meet with the welder later that week, and made an agreement about the work to be done.

Monday, I sent five text messages to five volunteers of patients I was coming to visit at their homes that morning. Alex, the nurse coordinator, is in Nairobi attending a course on palliative care. So, I was alone on the visits with a patient assistant and the hospital driver. I was really relying on the volunteers for information about the patient.

I sent the messages at about 8:30. By 9 am, I had received confirmation from all of them that they would meet me at the patient’s home. We travelled from patient to patient – starting at 9 and finishing about 3. At every patient home, the volunteer greeted us. Several of them had travelled over an hour by bicycle to meet us., and had waited for quite a while for us to come!

I was humbled when they thanked me for visiting their patients…and I tried to convey my appreciation to them for all they do.

Mgabe wearing his backpack developed by Rice University with his volunteer supplies

Discussing how to get the wheelchair on the back of the bicycle

Ready to travel!

A thank you!

July 24, 2012

A heartfelt “thank you” to the families that gave me ankle and foot braces that their children had outgrown to bring to Malawi.

This little girl came to the hospital for medicine and physical therapy. I was happy that the ankle braces I brought fit her well, and will help her learn to stand.

I am not sure why it always works out that the braces I bring fit the children that come my way while I am here. I am grateful for that, and for the generosity of the families across the ocean.

Alexander Jr.

July 20, 2012

Last year when I was at St. Gabriel’s, Alex and Mary were waiting for the birth of their child. We were glad to hear of his arrival in September.

Welcome, Alex Jr.!

I have had a lot of fun with him. He has a beautiful smile, is very active, and keeps his twin sisters busy. Unlike most children his age, he has not even been afraid of me, because of my white skin.

Here are a few pictures of Alex Jr., his twin sisters, and dad, Alex. Alex is the home-based palliative care nurse that I have worked closely with for seven years. His wife Mary is a mid-wife at the hospital.

Alex Jr.

Twin big sisters

Moving forward

July 19, 2012

I was fortunate that the American Physical Therapy Association T-shirts that I send arrived! These shirts were made for Physical Therapy Week in the United States with the theme of Move Forward…Physical Therapy Brings Motion to Life.

We had a chance to gather on Friday morning and have fun opening the boxes and finding the right sizes. I encouraged them to wear the shirts with pride – they are showing their fellow students at the Medical College what physical therapy is, and will be introducing their profession to the country in a few years.

It was great to see their enthusiasm!

Looking for evidence

July 18, 2012

The students are indeed tech savvy – but their resources online are scarce. With the partnership of the American Physical Therapy Association, it was arranged for the students to access the association’s Hooked on Evidence website. This site will provide the students with links to medical libraries, case scenarios with article summaries, a search tool that leads to article summaries, and a list of groups gathering evidence-based information.

We were able to reserve the computer lab on the Medical College campus for two hours so that the students could learn about the Hooked on Evidence website. The students sent many thanks to the American Physical Therapy Association for the opportunity to access the site. They now have many doors opened, many sources of information, and join many colleagues across the world in the pursuit of physical therapy practice grounded in evidence.

Computer lab reserved just for the Physiotherapy students! Posted on the door with a list of items that were lost, but now are found.

Connected to resources through a portable device.