Mary in Malawi

Wisdom of the month (came up with this myself actually!):

 "critisize in private, and appreciate in public"

Nice, huh? Only you have to know about you're bad sides, but it is good for everyone to know each others good sides.


Even dogs are human, and need to shower from time to time! =) Spot has now been washed with anit-tick and anti-flee shampoo! =) He was not very happy about it, but he didn't protest either.. =)

Love <3

Ngairi at the lab told med that Spot is a pure border collie! =) He is the sweetest dog ever.. I will miss him most of all here when I go back home... I wish I could bring him. But I guess he would not like to walk in a leech, or to live in a apartment... He is  used to have all the freedom he wants. And also, He has (at least) one wife and (at least) one puppy here =) So I guess I can't make his pup(s?)  orphans... =)

* * *
Well, I can tell you that I am actually exhausted. Worked a lot the last days, and  I took an extra shift this sunday. It was very busy, I was in chrage of the ward and many patients where very sick. I wokred 7 am til 7 pm, without lunnchbreak, because I spent my lunchbreak in an ambulance with a very sick man... But it's ok, I kind of
like it when it's busy.

so we take care of the patients before and after surgery. Most of the patients are woman who have had a ceaserian section. Thats quite nice, the babies are so cute and there are a lot of laughter. everyday startswith some morning paryers, we sing and those who can stand up and claps their handss or maybe dances a little. It's very nice.  But surgiical is also a very sad ward. there are many woman who loses their baby in theater.. Right now we have three who's babies died just after delivery. On of them also had a ruptured uterus, so they had to remove it. She is young, her baby died and she has no longer the possibility to get children... It's very sad. And they have to share the same room as everyone else, and see the healthy babies everywhere.. It must be torture. But one thing that makes a big impression on me, is their ability to recover. This girl whose uterus ruptured, for example. She was in theater on sunday, baby dead, no more uterus etc... And today, thuesday, she was laughing. She was laughing at me because I tried to speak chichewa with her, and it must have sounded very funny... So she was acutally laughing. And I'm so  impressed, I don't think a woman who jsut gone through something like that would ever be ablee to be happy again... at least not for a veeeery long time.  So thats quite amazing.

Tomorrow is wednesday. This means church-day! =) Every thuesday we have to be in church at 7 am til 8.30 am. It is actually very nice. The preacher is do funny, he dances and sings, and sometimes other staff members rises up and starts dancing as well. Im not christian, but I must say I enjoy going to church here. Link took a little movie, but unfortunately it wasn't possible to put it on the blogg...

Yesterday we had a very nice barbecue at a house up in the "djungel" ;). One of our dutch friends, Gervim, went home to holland today, so it was kind of a good bye dinner. We'll miss our eye candy!!

Right now we are out of water in the house.... after they installed the hot water geyser (YES!!! We are now proud owners of HOT WATER!!!! WOHOOO!!!) something went wrong (we  think) so now there is no water at all.. And there where no electricity the whole day. It disappered at 6 am. But we called Justice, as always our guardian angel, at 5 pm and he came and fixed it! =) So now it's only the water.. but well, well... Pangono, pangono as they say in Malawi. Take it easy, hakuna matata! We'll survive ;)

I also got a nice malawian nurse uniform today! =D so now I look like a lady instead of a... body bag as I usually do at work. The uniforms here are sooo nice., Why can't we have uniforms like that at home??? They are nice, pretty, feminine and yet classy, so it's not sexy. Ooo I wish we didn't have to be so "unisex" all the time at home....
I'm now allocated at the surgical ward, so we take care of the patients before and after surgery. Most of the patients are woman who have had a ceaserian section. Thats quite nice, the babies are so cute and there are a lot of laughter. everyday startswith some morning paryers, we sing and those who can stand up and claps their handss or maybe dances a little. It's very nice.  But surgiical is also a very sad ward. there are many woman who loses their baby in theater.. Right now we have three who's babies died just after delivery. On of them also had a ruptured uterus, so they had to remove it. She is young, her baby died and she has no longer the possibility to get children... It's very sad. And they have to share the same room as everyone else, and see the healthy babies everywhere.. It must be torture. But one thing that makes a big impression on me, is their ability to recover. This girl whose uterus ruptured, for example. She was in theater on sunday, baby dead, no more uterus etc... And today, thuesday, she was laughing. She was laughing at me because I tried to speak chichewa with her, and it must have sounded very funny... So she was acutally laughing. And I'm so  impressed, I don't think a woman who jsut gone through something like that would ever be ablee to be happy again... at least not for a veeeery long time.  So thats quite amazing. 

I also learn a lot of post-op. care. That's really good, 'cause I've almost never had surgical patients before.

Tomorrow is wednesday. This means church-day! =) Every thuesday we have to be in church at 7 am til 8.30 am. It is actually very nice. The preacher is do funny, he dances and sings, and sometimes other staff members rises up and starts dancing as well. Im not christian, but I must say I enjoy going to church here. Link took a little movie, but unfortunately it wasn't possible to put it on the blogg...

Yesterday we had a very nice barbecue at a house up in the "djungel" ;). One of our dutch friends, Gervim, went home to holland today, so it was kind of a good bye dinner. We'll miss our eye candy!!

Right now we are out of water in the house.... after they installed the hot water geyser (YES!!! We are now proud owners of HOT WATER!!!! WOHOOO!!!) something went wrong (we  think) so now there is no water at all.. And there where no electricity the whole day. It disappered at 6 am. But we called Justice, as always our guardian angel, at 5 pm and he came and fixed it! =) So now it's only the water.. but well, well... Pangono, pangono as they say in Malawi. Take it easy, hakuna matata! We'll survive ;)

I also got a nice malawian nurse uniform today! =D so now I look like a lady instead of a... body bag as I usually do at work. The uniforms here are sooo nice., Why can't we have uniforms like that at home??? They are nice, pretty, feminine and yet classy, so it's not sexy. Ooo I wish we didn't have to be so "unisex" all the time at home....




 Blood spattered! =) Me and doctor Hector after big, abdominal sugery.

Malawian traffic rules

1. Never stop

2. Pedestrians: Move or die.

3. The horn is there to be used. The more, the better.

4. Goats are stupid

5. Green light: Drive

6. Yellow light: Drive

7. Red light: Drive faster

8. Muzungus always have to pay in road blocks

9. Malawians are allowed to fill their car whit unlimited number of people

10. Muzungus must have the same number of people in the car as there are security belts, or they have to pay in the road blocks

How to get a working permit in Malawi

1. Keep signatures of every person you every spoke to in your life

2. Take the list of signatures and attach it to David Bowies favorite pants

3. Fint three tee spoons of dust from a unicorns horn

4. You must have visited the moon at least twice during the last six months

5. Find the holy Grail and get it's validity confirmed by jesus or other truthworthy divinity

6. Tuch your elbow woth your tungue

7. Walk on one hand up and down kilmanjaro...

Reggae time!

After a hard weeks work, we spent a lovely weekend at Cool Runnings, a completely wonderful place by the lake.
Theere were a lot of children playing, they lived in little houses right next to the beach. the locals swam, fished and washed their clothes by the shore. It was really nice, to see the real lake life. This pretty girl came and sat with us on the beach. She didn't talk much, but she was extremely cute. She actually curled up next to me on my towel! So sweet!

 

there were also three really nice rastafari-guys on  the beach! Isac, Easy Tiger and Chocolate. They lived of making wooden art. They sat on the beach all day, smoking, listening to reggae, making art and selling it to people. They taught me to play the bow-game; a famous african game. On the picture below, you see me and Chocolate playing =). Easy Tiger also took us in
his boat to Lizard Island; An Island where it lived GIANT lizards, they could be up to 1.5 metres! The whole island where as it was taken from Jurassic park or something, untuched by man, full of bird shit and giant trees and leaves... everything was in Extra large, we felt so small! And we saw two lizards! they where HUGE! But also, unfortunately, very fast so I didn't get a picture. Here below, you can see Easy Tiger, Me, Rebecca (med. student) and Liz (med. student) on the island. The rocks where all white, like snow. And it was all bird shit. Nice... ;)



We also didd some snorkling by the island; I saw a lot of fishes I recognized from my fathers aquarium! =) Very nice! We stayed until sunset, and then we went back to the beach for dinner, wine and reggae! Life is sweet!

13 July; Birthday!

Happy birthday to me, happy birthday to meee! =D  The day started with christian calling me, singing for me in the phone =) Thank you darling =) Love you!!!

Celebrated my birthday at the OPD, draining abscesses, giving injektions and fun stuff like that =D

Then we had a birthday party! A lady that volunteers as a teacher here, Dorothy McKenzi, also had her borthday today; she turned 80! So we got together and celebrated 105 years anniversary! =D

We made a lot of cakes, I think there were at least 15 different cakes.. I made two chocolate and one apple/vanilla (thanks mom for recipe! =))

Some malawians came over to congratulate us.. Efrida and Riffiness; two nursing students who now works in maternity. Our gardener Wilfred watson and our cook Viktor, and our beloved friend Justice Khimbi also visited =)

Now me and Link is sitting in Justice's office, trying to get the internet to work. Tina just called!! So nice to talk to her again!! Miss her SO MUCH! But the telephone line is (pardon my french) really SHITTY so the call was cut... =( Also, Nyathipa tried to call med earlier and she very nicely tried to sing to me =D But also, the f****** phoneline got cut.... I also spoke a little to my mom on the phone, it didn't get cut, but the reception was very bad... =( grrrrr.... Well well.. Thank you so much everyone, for trying! =D Love you all!! =D

12 July

Monday! And I'm in OPD; Out patients Department. This is the ward where the patients are admitted and ”triaged” if I can put it that way. They line up, comes in and gets seen by a medical asistent (someone who has had two years of intense, pure training in medication). The MA looks at the patient, and decides whaat drugs she or he should have, writes it in the patients little book and send the patient to the pharmacy and then home. If the patient is very sick, he/she gets admitted and gets seen by a doctor on clinical officer (someone who has the right to do nursing aswell as surgical procedures and prescribe medication). As a nurse in OPD, you check the patients who are in line. If someone is very sick, you put her/him forward in line. You also assist in a room called CASUALITES; where I spent most of the day. In that room, patients come to get wounds dressed, get injections and to get minor surgical procedures done, like repairing a broken leg, drain an abscess etc.. Also emergency surgery is made her. Sometimes it is very busy, and sometimes very calm. Today we had some wound dressings and some abscesses. An abscess is an infection bound to one spot of the body, like a cyste. When the infection gets worse, the cyste grows into a big ball. It is very painful, and you have to get it drained. You drain it by cutting deep down, put your finger in and ”break” everything inside the cyste. A lot of pus and blood comes out, and then you leave the wound open for drainage. We had a little boy with a GIANT abscess on his back. We drained it for approximately 250 ml of pus (!!!) Thats a LOT. 2 and a half deciliter.... Nice....!

We also had a lot of wound dressings. A lot of burn wounds, animal bites, knife-accidents etc... Some patients comes in because they have been bitten by a relative or another person, in the nose or the ear... Someone have been in a fight. And no matter what wound it is, they clean everything with chlorine or pure spirits. At home we only clean with sodium chloride (saltvatten).

I went to the lab a few days ago, to get tested for malaria. And the girl who works there asked me for my blood group. It is O Rhd Neg, allso called ”emergency blood”. It is very rare, and also is the only blood group that can be given to everyone, no matter their bloodgroups. She was really happy, because they didn't have any donor with that bloodgroup. So Im the only one =). If there is an emergency, they will call me and I will donate. Cool ;)..

Also, today I've been baking cakes! =D Birthday tomorrw! Woho! =D

9 july

One week at peadiatrics have passed, and it has been an interesting week. I think I've admitted hundreds of children with measles.. As I wrote earlier, we have an epidemy here right now and people are being mass vaccinated. Unfortunately, that doesn't help the ones already sick. In sweden and Norway we all get vaccine against measles when we are little, so me and Link are safe. Wich is very good, 'cause it is impossible to isolate people here and I probobly have measels organisms everywhhere on my body and clothes.

We also have a lot of malaria, tuberculosis and burn wounds. In malawi, it is very common with grass fires, and a lot of children play close to the fires and easily gets burned. Also, a lot of them gets injured from boiling water.

What most children die from on this ward, is dehydration and malnutrition. We had a little baby coming in, a 2 years old girl. No body could give her an iv canula (venflon), it was completely impossible. So she couldn't get any fluids, and she died a few hours later.

I have 3 children on this ward I care extra much about.... They are all very sick; a girl with pneumonia + malaria, a boy with measles+pneumonia and a little boy with HIV, malnutrition, dehydration, tuberculosis and malaria. The girl, Joyce, has had to little oxygen in her blood the last week, so her brain is probobly injured. We saved her life yesterday. She couldn't breath and everyone thought she was gonna die. But I convinved a doctor to give her furosemide (diuretika/vätskedrivande) to get the fluid out of her lungs, and he let me do it. And she got much better. Now she is no longer dying, but we have to figure how to treat her and with what. She has been on iv antibiotics for over one week, and she only gets worse.

The boy with measles and pneumonia is almost the same story. The problem with this boy is that he needs oxygen treatment to survive. And to get the oxygen, he must be in the same room as the other kids, because there are no oxygen machine on the isolation room. So he is now contaminating other babies. And we xon't know how to solve it. We can't sacrifice him, but we can't let him spread measles among the severly sick childre, like Joyce. So this is a problem. We are now trying to get a oxygen machine moved to isolation, I hope it will be there on monday..

The third baby, named Akim, is 1.5 years old. He weights only 4 kilograms. He is so tiny, you could almost think he is a premature baby. He has a lot of wounds over all his body caused by HIV and malnutrition. He also has a severe vitamin A deficiency, which you can tell from his eyes. They are covered with a grey layer, almost like catharax (starr.) I gave him vitamin a and called for the doctor to check on him. The doctor says he is most likely going to die very soon. It is so sad, he is such a sweet baby. And his parents and grand parents are there all the time, praying by his bed.

There are so much sad things here... And everyone is so poor. Some patiens refuse treatment because they dont have the money to pay for it. I've seen mothers refusing treatment for there own children, cause they can't afford it. It feels so terrible inside, I could in theory pay for them... But not for everyone, and if we payed for one, everyone would come and ask... Thats the worst part herer, that you can really see that money makes all the different. If you have money, you survive. Simple as that. And it is a terrible insight, especially if you have money yourself to pay, but in the same time you know that you can't...

But I think I can try to help those I get to know, like our gardener and our maid and house guard. They are also very poor and hard working people, who tries to support a big family.

The internet is not working now, so I'm not sure when i can post this.... well well.. Tomorrow it's saturday = Lilongwe day! =) And on thuesday... tada! I'm 25! Half way to 50. Yey! =D

10 July

Eeeeeeeeeee.... Ick. Been up all night, vomitting. High fever. I didn't check my temperature, but i guess it was pretty high.. After vomitting in a plastic bag, I was so convinced that the vomit was poisonous, so I walked out in the middle of the night, trying to find our gardener (??) so he could help me burn the bag..... After walking around for a while, I realized that our gardener didn't workk during night time and that I acted crazy. So I went to bed again. Couldn't sleep though... Spent most of the night on the toilet, prepared to puke... But I didn't puke anymore. Luckily. It is really nasty.

Considered not going to lilongwe, but I felt perfectly fine in the morning so I went. It was OK, but maybe I should have stayed at home... Got really bad fever again. Took two paracetamol and went to bed at 5 pm, immediately when we came home from lilongwe. I also took a malaria test. But it was negative. Talked to doctor Rona about it, and she says that everyone who has been working in peadiatrics had been very sick, even malawians. And where do I work? Peadiatrics! =) So she said it is probobly something viral, but nothing we can do anything about. Just sleep and drink lots of water. So thats what I will do...

I would also like to make an announcement; Goats are the most stupid animal on earth. When a car comes, driving stright against them, the goat acknowledge the car and starts to run around confused in the middle of the road, and then stops in the middle. And gets hit. Everytime! They never realize that they can run away from the road. They just stays in the middle. And sometimes they stand by the side of the road, watching the cars. And just when a car passes, the goat runs out in front of it. They're extremely stupid. Or maybe suicidal... I don't know. As you can guess from this blog entry, we have A LOT of goats in Nkhoma. They're everywhere! And people transport them in hideous ways... They lay them on top of each other, and ties them to the back of their bikes. And bike like that, with the goats screaming. For hours. It's really sad to watch... But here, goats are food, and thats about it...

Also I think we had a big pig sale yesterday.. People where coming from the hospital with live pigs on their backs... We stopped and said hello to a lady with a pig, and I petted the pig. Og, how they laughed! Musungo, musungo.... hehe. Musungo means ”white people”, and we hear it a lot when we do something considered strange....Like petting the food, for example...

11 July

Sunday! Felt much better today, think that the long hours of sleeping and the (too?) high doses of paracetamol and ibuprofen cured me.. So we went to Dedza. A village about one hour car drive from Nkhoma. They had a pottery there, where they sold hand made ceramic pieces. It was really nice! And they had a good restaurant. We also went up on Dedza mountain, about 2100 metres above sea level. Nice!

I also went back to the hospital to check on the little baby with malnutrition.. But he was dead. He died the same day we admitted him. His mother had taken him home. This means, she ties him to her back and she walks. No matter how far. They always carry their dead. It is very rare that anyone can pay for a special transport, and it is not allowed to bring dead bodies on the minibuses. So almost everyone has to walk. This baby came from Dedza, and as I mentioned before, it is one hour car drive... Imagine walking.. with your dead baby on your back. Terrible.

And they also carry their dead adults... It is difficult even to imagine...

But when they die here, at the hospital, it is pretty amazing.. when we confirm that someone is dead, all the guardians starts to cry loud and open. And the other patients and their guardian also join. So everyone kind of shares the sorrow.. Then we clean the body, and wrapps it in blankets the guardins have. And then everyone in the room has to be quiet, and we pray together. One of the nurses prays loudly, and everyone else joins her och stays quiet. It is actually really beautiful.. And then we take the body to the morgue, and everyone we pass on the way there, rises up and either follow or bow and pray. Some starts singing. I remember a lady who died two weeks ago.. She had about 5 guardians at the hospital. But when we reached the morgue, about 40 people walked behind her body. Singing, praying or crying. A lot of them didn't even know her. It felt worthy, it felt like everyone showed their respect and shared the burden.. This is something that would never happen at home..

Aaaaa the internet is unusually slow today... one hour to open an email... gaaah.....

I must excuse myself, I've not been very good at answering emails.. Sorry about that. But that is because it takes so long time. Today my focus is to check my internet bank... And that takes all my energy... Hopefully I get to post this.... Would be lovely to check my facebook. I can see that i have some messages there. But i can't open them. It is extremely frustrating... Does anyone remeber when internet was new, very few people had it?? I remember it... But I can't imagine it. Strange, huh?

3 juli

Morning
*******
I am pissed. Today, Saturday, people were calling me on the phone and knocking the door, and calling "helloooo?" outside the house from 6 am til 8 am in the morning. Just to say Hi. Whyyyyy????? I mean, they just want to be nice.... But please, not 6 am saturday morning!!! Crazy.

it's cold outside.. We have no hot water. Still...! The problem is: We live in a house owned by the nursing school. We work at the hospital. The hospital thinks that the nursing school should fix it. The nusing school think the hoospital should. So they are arguing. And we are freezing. Three weeks now, no hot water.

Probobly you think ”Aaah, she's in Africa. It's for sure hot enough”. But let me tell you; NO. It is so cold! It is extremely hot during three hours every day. Between noon and three o clock. The other 21 hours it is cold and cloudy and dark. Nkhoma is in a high lanscape, lots of mountains.So it's colder then the rest of the country. And right now it´s winter here. July is supposed to be the coldest month, so it will get colder...  It would be OK if we had hot water. Gaaa.... =(

New intresting cases:

A young man whose brain was leaking out of his ear and nose. He had been punched in the head and he got a subarachnoidal hematoma (bleeding in the meninges). The pressure increased in his brain, so his brain started ”coning”, i.e it didn't have enough place in the skull so it started to get pressed down the spine. This man was in so much pain, I've never seen anything like it. He was screaming, scratching the wall, ripping his hair... It was terrible to watch. To survive, he needs brain surgery. But there are no brain surgery in entire Malawi..

Another young man lost his kidney function. We don't know why. He stopped producing urine and he had a kreatinin over 1500.. And for you who work in a hospital, you know what that will say.... I think the highest i've seen before was about 600.. And that was crazy high. To survive he needs dialysis (Mechanichal cleansing of the blood). But we have no dialysis in Nkhoma. They do have it in Llilongwe, but that is maybe 1.5 hours car ride away, and he wouldn't survive without oxygen (I suppose I don't need to tell you that we don't have any portable oxygen tubes?). So, At home this man would survive. Without a doubt. But here, we have to treat him palliative.. We tried to improvise ”home-made-dialysis”, i.e we gave him A LOT of intravenous fluids, and A LOT of furosemid (diuretics/vattendrivande) to try to flush his body of toxins... It was a long shot, It could have worked, but it didn't. No urineproduction at all. I saw him last time on thursday. I suppose he is dead now. I hope so, He was in so much pain...

Ok, I also have some GOOD news! =) The little premature baby ( her name is Gertrude) survived! She has now been discharged and went home with her twin and her mother. There is of course a big risk that her brain has been damaged in one way or antoher, but time will tell I guess...I wish her all the best no matter what.

 
Afternoon
********

Ok I am in a little better mood now. Went to the market today, it is a huge market here on saturdays. You can find almost everything.... (if you don't care so much about good quality, of course...). It was very nice! I had company by Link and a doctor from the eye department.

(F*CK!!! The power broke. Blackout. F*ck F*ck F*ck!!!!! Ooo now It came back... Thank God....)

Ok where were I... O yeah, the doctor from the eye department. He is about 70 yrs, and workd here as a volunteer for a few weeks. He is very nice! =)
Also Spot (our dog) joined us to the market. He walked with us through (yes, through) the hospital and all the way to the market. He helped us shop ;) People where somehow a little scared of him.... ;) hihi! He is such a lovely dog.

I also met a friend from the hospital there. Efrida. A third year nursing student here in Nkhoma.

Oh, and we saw a man with a machine gun on his back! Fully dressed in military outfit. Don't know why, Nkhoma is so peaceful it's almost boring (but just almost. It's very nice here, actually).

Real malawians at the market! =)


Now, the internet is starting to collapse again, but at least I got to post this and check my fb and talk to Christian for almost 40 minutes on skype!!! =D I miss him so bad.. It really hurts. And also when nothing works, electricity is shit, water is cold and internet is solw as a snail with lots of luggage I miss him even more...


Yesterday evening we had a little "party by impulse".. We were chatting outside with out gardener, security guard, cook and some of their friends. Then some beer came out... and some music... and then I made food... We were totally 9 people! =) Very nice!


Sikomo!
//Maria