Adventures Part 2

December 29, 2015

It was fun to have the UOP students here to share in daily trips to the market or just a walk around the local villages. You don’t have to go far to come across something you weren’t looking for. If you head out to the market with a list – chances are you won’t find most things on the list (unless your list includes only tomatoes, onions and cabbage). But, you will find something unexpected. If you set out to find someone, you might find them – but you will meet someone new for sure. Oh, and the quick changing weather can provide another chance for an adventure as well!

Here are some pictures of some of those everyday adventures.

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I went for a long run – had a nice breeze that made the scorching sun tolerable, napped, read, worked on a research proposal and took a long semi-warm shower.

It was a quiet day…until, as I sat on the porch, I became aware of all of the noises. It is really “noisy” here in the Zitha house. The Zitha house is about 100 yards from the entrance of the hospital and close to other homes/apartments. Lots of people, yet lots of space for the natural world. Not “noisy” as I would usually think of the word, but filled with people and nature noise. The kind of noise that is soothing, interesting and refreshing.

I wrote down some of the noises I heard this afternoon:

Children chatting, yelling, squealing (definitely the prominent noise of the afternoon)

Birds singing

Roosters waking us up (all day long)

Adults talking, calling to each other and to the children

People walking (shuffling, running)

Bicycles traveling, brakes squeaking, chains clattering

People sweeping (they even sweep the dirt road)

People singing

Babies crying

Owls hooting

Stick noise (children breaking sticks, banging sticks)

Rock noise (children throwing rocks, banging rocks)

Dogs growling, barking, running, howling

People yelling at the dogs

Insects chirping

Laughter

Water running, being poured

Doors opening and closing

Hoes digging

Wood being chopped

Wheels of an ox cart turning

Pans banging

Mosquitos buzzing

Objects being dragged (sticks, large pieces of wood, metal pieces, buckets)

Wind

Rain (we even had hail this afternoon!)

As I’m getting ready for bed this evening, it’s not as “noisy”…but by 4:45 when the sun comes up, I’m sure it will be again.

Growing families

December 26, 2015

I spent the afternoon on Christmas visiting two families that have become part of my own. Over the past ten years, I’ve seen these families grow. Pictures tell the story of Grace, Malifa, Roderick, Alec, Patso, Christopher Dallas, Dorothy and their parents.

First, a look back over the years…

Grace and JoshGrace Frist GradeIMG_2441Malifa and Rodrick Primary SchoolIMG_2431IMG_1450Dallas Young

And, now – Christmas, 2015…

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I had a wonderful dinner last night on Christmas Eve with Sister Justina, her cousin, a new doctor from Germany and his wife, and Father William. It was nice to share news about our families, and listen to their ideas about how things are now in Malawi. Sister Justina has been here since 1968, so her perspective is always enlightening. There will be hunger next year, she says – as there is this year – because of the lack of steady rains. There is always a story of political corruption from the past year (nothing unusual for a developing democracy). And, there is the popular topic of Escom – the national electric company. The power has been on for only a few hours each day, unpredictably. The hospital has run a generator for the houses nearby for another few hours so we have some time to cook (You have to have everything chopped and ready to get your meal cooked in the 30 minutes of power! And yes, pasta cooks – eventually in warm water).

This morning, Christmas morning, I went for a nice run, had cereal with fresh mangos and went to church. I don’t understand it all, but it was nice to have someone next to me with a Mass book so that I could participate by reading the responses. The singing and dancing were beautiful. Participation is mandatory – if you don’t get into the rhythm (which I don’t!) you get jostled around in the packed rows.

Before the British doctors and UOP students left we decorated the Christmas tree in the house with snowflakes. It’s hot and rainy, but we were dreaming of a white Christmas (much like many parts of the US). The power was out, so the evening was spent being creative with a few colored pencils, fingernail scissors and sharp knives. The taped shape of a Christmas tree was there from two years ago (when the theme was paper animals).

This afternoon, I’ll visit some families and distribute some gifts of clothes left from the UOP students. If there’s power, I’ll probably cook together with the German pediatrician who is staying at the house here.

I’m thinking of all of you.

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Uncertainties

December 22, 2015

Supporting students in a context with so many uncertainties can be challenging – but also offers incredible teaching moments. During our days providing physical therapy services together at St. Gabriel’s we worked together closely. The focus of my clinical teaching here is not only on the biomedical aspect of clinical reasoning, but also on the narrative aspect. Ethical decision making is a huge component, as well. Because the medical diagnostic information/resources are limited, often it is the narrative that guides the clinical decisions. Reflection on the patient story, personal values and the context of the institution/culture/country resources is key.

Always, the context of the culture as well as the state of health care in the country is important  for the patient centered approach. We reviewed medical information, developed a plan for our sessions, decided on roles for each team member for each session, implemented the plan, reviewed what went well, talked about what could have gone differently, and made a plan for the next patient visit. By the end of the week, we were able to work very well as a team. The students were developing their independence as well with familiar patients. We could provide physical therapy for two patients with similar conditions simultaneously on the wards. They also quickly learned how to assess, treat and educate the family – often all at the same time. We often don’t know how long a family will stay at the hospital because it is planting season and the young men want to be out home in the fields rather than at the hospital caring for their loved ones. So, family and patient education is the most important aspect of my care here.

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Adventures Part 1

December 21, 2015

It’s hard to believe that two weeks had gone by and the students will be on their way home today. We’ve had a lot of adventures in addition to the hard work providing the training and physical therapy services in the hospital.

Here are some pictures of our trip to Lilongwe – the capital city. It’s about 50 km away and just getting there is an adventure on the bike taxis and crowded mini bus. Travel can be interesting in the heat and rains.

The students shopped at the craft markets for Christmas gifts for their friends and families. For the past two weeks, they have had a fantastic approach to the unknown – filled with curiosity and smiles. I always learn a lot along the way, too! I’ve always eaten the roasted corn like corn on the cob – but we were corrected by the ladies in the mini bus to first take the kernels off and then eat them with our hands rather than biting them off the cob.

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I and the UOP students have been very busy providing physical therapy services at St. Gabriel’s this week. Our days start in the clinical meetings where we get the report from the night duty nurses, hear about new admissions and special cases. At the conclusion of the meeting, the medical director sounds the bell with a quiet voice, “Let’s start our day”.

If your wondering how we find our patients at St. Gabriel’s – the answer is simple – in the corridors of the hospital as we move around from ward to ward. We are stopped frequently by the clinical officers to come to consult on a patient. Often, one patient leads to many others. Our base is in the palliative care unit, but we have treated patients on every ward this week as well as in the outpatient department and wound care room.

Patient’s here have a wide variety of medical diagnoses – some familiar and others very unique to this context. Some of them include: CVA, cancer, severe cerebral malaria, burns, joint sepsis, fractures (of the young and old), motor vehicle/motorcycle accidents, epilepsy, burns, cerebral palsy, and complications from difficult births. Many patients have multiple illnesses that complicate their medical management as well as their rehabilitation.

The student have written the stories of several of their patients on their Beyond Pacific blog. I invite you to read them and share your thoughts about them with the students.

More later about the teamwork the students developed, but here are a few pictures of them at the hospital.

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