Schisto, anyone?

This past weekend was one of my best weekends here so far since I’ve finally settled in and made friends and know about different events that are going on in town. Friday night my friends and I went to check out a famous musician from Zimbabwe, Oliver Mtukudzi’s and the Black Spirits. The concert was fantastic. It was held outside in the courtyard of one of the nicer hotels in town under a large tent. There must have been about 1,000 people there. I was surprised that so many people made it out since the tickets were pretty steep – 2,000 kwacha, about $14. But as our housekeeper, Godffrey, who really wanted to come put it, “I buy 10 chickens for my family for that price – ahhh, no, Godffrey will not come.” Although pricey, the show was a wonderful cultural experience. Oliver Mtukudzi and the Black Spirits combine South African and Zimbabwean pop music with traditional kateke drumming to create uplifting beats. The band’s lyrics, sung mostly in the Shona language of Zimbabwe, address both social and political issues of the African continent. I was relieved when half way through the concert, everybody rushed to the dance floor and alas, the dance party had begun!

Towards the end of the night, my feet needed a rest and I found myself sitting on the sidelines in the company of a Buddhist monk. He couldn’t speak English and since my Hindi isn’t that great, our ability to communicate verbally was very limited. We ended up communicating with our digital cameras. He showed me his pictures and I showed him mine. His final comments to me were, “India good, America bad.” He was on his way back to his home, Dharamsala, India, and was clearly very ecstatic to be homeward bound.

Saturday morning, three of my friends and I headed to Lake Malawi. It was quite an adventure as a significant part of the journey was made on dirt roads that wound around through mountains passes and had large potholes that were generously scattered everywhere! Luckily, our rental car was a Rav4 which handled the dirt roads and the potholes very well! It was my first time driving a manual car on such crazy roads and I have to admit, it was actually really fun! I was initially a little concerned about the roads as motor vehicle accidents are a very common cause of death in Malawi but we were very careful and luckily, our journey was safe. On our way to the lake, we made a pit stop in a town called Dedza. Dedza is a quaint pottery town with a café that features cheesecake and coffee! The pottery was in fact beautiful and I ate my fair share of cheesecake, chocolate cake and chicken curry. A very random yet satisfying combination of flavors!

Lake Malawi was beautiful and it surpassed my expectations. The area where we stayed was a little south of Cape MacClear which is a very crowded, party central location with lots of tourists. Apparently you can stay out until 9 am and go to raves, etc. Not quite the experience that I was looking for! So, I was pretty happy when we arrived at our lodge. It was situated on a deserted, remote, quiet part of the lake with sand, clear blue – green water and a bar right on the water. I was a little torn as to whether I should swim in the water or not because of the schisto, but everyone who swims in the lake just treats themselves as if they do have schisto. And since the water was so beautiful, the weather was perfect and sunny and my friend had brought his snorkeling gear, I couldn’t resist swimming and it was totally worth it! Aside from swimming, snorkeling, soaking up schisto, hiking around the lake and exploring the terrain, we spotted some large, leaping, iguana – like reptiles and eagles, played spades for about 5 hours, were serenaded by a local band called the “The Freedom Band,” and before we knew it, it was time to head back to the city of Lilongwe. On our drive back, we stopped in Dedza again to inhale more cheesecake, chocolate cake and chicken curry. We also attempted to chase the sunset and get lots of pictures but the sun sets within a matter of seconds here!

This was definitely a great little adventure and I’ll be heading to the pharmacy soon to snag my dose of praziquantel in hopes of quelling off any cerceriae that may have penetrated through my skin!

Hope this finds you enjoying the beginning of summer and happy Memorial Day weekend! Peace.

Sima ;)

Post #2

Dear friends,

Hope this finds everyone doing well and enjoying whatever it is that you’re doing!

Since my last post, I’ve been busy immersing myself in various clinical experiences, doing 7k races through Malawian brush land and villages, sailing, eating sugarcane, hanging out with my local friend and his cute children, “helping” harvest rice and doing Ashtanga yoga on my front porch with my roommate Rushina.

The setup here is really nice. I live in a house with one of my friends from school, Rushina, a UNC MD/PhD student. We live in walking distance from the Tidziwe Center, which is a building that has a lab, office space, some clinics and a wonderful library with a lot of good medicine books. It’s the home base for the UNC Project. Kamuzu Central Hospital, the hospital that I’m working at this week, is also within the same complex. It’s very convenient because I’m able to walk to work.

My first couple of days was spent working in an STD clinic which was pretty interesting. I was actually able to communicate with a lot of the clients since they could speak English. Most people had so much pride about their HIV serostatus which was surprising but I guess it makes sense given the context. If they were nonreactive, they made it a point to let me know. There’s one young couple in particular that stands out in my mind. They had taken a three hour bus ride to come to the clinic. The 24 year old wife had her hair carefully done and wore a beautiful traditional outfit. When I was going through the history and asking about HIV testing, the husband looked at me and said, “Dear Madame, we are a God fearing, Christian couple and we don’t have HIV. I want you to know that.” He made us do an HIV test on both of them (even though his wife didn’t want her finger to be pricked) just because he wanted us to know their status. He told us, “We are proud and want everyone to know our status. We have nothing to be ashamed of.” Even though AIDS is so rampant here, the stigma associated with those who are HIV positive is overwhelming.

I also found myself shocked by the number of coffin making shops in town. On my drive to Bottom Hospital, another hospital that I worked at last week, I was horrified by the number of shops there are that make coffins. One street is lined with these shops. There’s one after another. It’s a popular livelihood, making coffins, since so many people are dying every day.

I don’t want to end on a dark note since there’s plenty of lightness here. So I’ll just say that with all of the death, havoc and chaos that the HIV epidemic is wreaking here in Malawi, the people are very resilient indeed. Just today I was in the admitting room of the hospital, working with an AIDS patient whose condition was drastically deteriorating. Amidst her gasps of pain, horror and misery, a group of four women encircled her and sang a beautiful song of prayer in Chichewa. I got the chills from hearing the patient’s gasps of agony but hearing the comforting, spiritual voices of these women gave me the chills in a way that I’ve never felt before. Something about their voices lifted my hope for my patient. And then a young gentleman who worked in the laboratory whom I had met while retrieving the patient’s CBC results came to the bedside of this patient. I looked at him inquisitively, wondering why he had come. He looked at me and said, “Dear Madame, I learned of this patient. I want to pray for this patient because God can help, I have seen it and I know.” These little gestures like seeing patient’s family members praying for and caring for the patients make all the difference. Medically, there are only so many things that can be done to increase a patient’s chances of survival. I feel comforted when I see a family member holding the hand of a patient or softly singing songs of prayer to lift their spirits. I also feel comforted as I work alongside doctors, clinical officers and nurses who don’t “knock off (leave to go home)” unless they are sure they’ve done all they can for their patients. These small acts of compassion bring a sense of hope amidst a sea of chaos.

Signing off until next time,
Sima

My first post!

Dear family and friends,

Muli bwanje! I’m settling into life in Lilongwe after about three days of being here. The community that I’m surrounded by is fantastic. People are very helpful and friendly…..from the local people who are eager to teach me Chichewa to the doctors that are excited to help me expand my clinical knowledge to my roommates who make good gin and tonics for malaria prophylaxis …… I’m ready and eager to embrace the experiences that I’ll have in the next few weeks!

Getting here was a little complicated and involved a lot of waiting, sitting around and Dramamine. I had a sixteen hour layover in Frankfurt so I decided to venture out amidst the cobblestone streets. I had plans to check out some art museums but as my luck would have it, they were all closed! Too tired to do any shopping, I settled into a little cafeteria to try to make do with horrendous German cuisine. Aside from the raw hamburger patties atop buns of bread, I managed to find some fruit, rice, vegetables and beer which cost me a whopping $20 US dollars. After my costly feast, I headed back to the confines of the airport, eager to just sit around and work on my master’s paper and fiddle around in STATA! The next 12 hours at the airport were pretty uneventful aside from a friendly young gal and guy from Algiers who amused me with their stories from their 6 month hiatus in the Ukraine.

The next leg of my journey from Frankfurt to Joberg was bearable with the help of some Dramamine. As soon as I sat down in my seat, I was out. I didn’t realize it but our plane had taken off 45 minutes late which would be a problem for me in Joberg. Once we landed in Joberg, I had 30 minutes to make my next flight to Lilongwe. This was a practically impossible feat, one that I was willing to admit that I couldn’t tackle. Alas, I missed my flight to Lilongwe. To my dismay, I realized that I wasn’t in fact, superwoman. I spent the next 8 hours at the Joberg International airport trying to figure out how I would get to Lilongwe as flights only run every couple of days from Joberg to Lilongwe. Then there was the hassle of trying to track down my bags, one of which is still missing! It was only the perfect combination of my disheveled appearance, my apparent distress and my nervous smiles of desperation that guided my 8 hour course at Joberg International Airport.

After numerous phone calls, waiting and hounding various people, things were starting to look up. The high point of my time at the airport in Joberg was when I found myself waiting at the Swissport station, the station where baggage is tracked. There was a team of about 10 South African guys running around the airport trying to track my bags. They weren’t too thrilled to be running around the airport looking for my bags but they were excited to talk to me. It must have been my apparent distress and my nervous smiles. They were especially eager to learn that I was a med student and used the opportunity to ask me questions about HIV. They had good questions like how do ARTs work, what’s the difference between HIV-1 and HIV-2, etc. I was seriously very happy to be answering these kinds of questions and was have fun giving this mini lecture series! Who would have known that my first prevention counseling session would be at the airport! As if talking about HIV to this group that was genuinely interested in getting information wasn’t good enough, things got even better. Lufthansa was going to put me up in a nice hotel and I was finally booked on a flight from Joberg to Blantyre to Lilongwe the next day!

When I finally arrived in Lilongwe, I was ecstatic! The hot sun and the humidity were enough to make me smile from ear to ear. But once I got off of the plane there was someone waiting for me, holding up a sign that said Ms. Sima Pendharkar. A driver there to pick me up with no waiting time involved! Although the drive to UNC Project was beautiful with rolling fields and farms the lack of greenery was a little surprising. In 1993, a major drought in Malawi had destroyed nearly half of the corn crops. Even today, malnutrition among children is a major problem that has devastating consequences like delayed growth, mental retardation and infection due to weakened immunity.

As we headed to the guest house where I would be staying, I tried to make mental snapshots of what I saw. Women walking alongside the road carrying loads of grain on their heads with children hanging off their back in cloth gurneys, other children trailing behind them in scant clothing, men bicycling down roads with no shoes on.

I was eager to learn more about the country and its people yet nervous about the challenges that lay ahead in the coming weeks. Would I be able to relate to these people? Would they trust me? Even though I’d spent the last few years studying hard and learning as much as I could, I would still have vast amounts of new information to tackle as the cases I would be seeing here are unique to the setting.

Armed with the firm belief that individuals can provide the impetus to move things and to transform dreams into reality, enthusiasm for opening my mind to this new culture and a passion for the knowledge that I would acquire over the next few weeks, I welcomed this journey with open arms.