Monday, June 11, 2007

Lions and Baboons and Impalas, Oh my!




The grand finale for my Africa experience was a safari adventure in Luangwa National Park in Zambia. It was everything that I always imagined a safari would be and made me a little nostalgic for the 5 months that I spent camping in the rainforests of Costa Rica during a Tropical Ecology study abroad program in undergrad. There’s nothing better than being able to gaze at an infinite blanket of stars at night, the constant smell of grasslands mixed with drying animal dung and being covered in a solid film of dirt at the end of the day!

Getting to Zambia from Lilongwe took about 6 hours or so. Danica and I were accompanied by two Dutch med students, a young Swiss couple, a somewhat disgruntled American SICU nurse and our fierce driver Saidi, who had an unending collection of thrilling safari stories to share with us. The strange dynamic of our group provided constant entertainment for Danica and I. Most interesting was the European folks’ constant lack of racial sensitivity which was highly offensive but eventually Danica and I learned to laugh at their crude antics and obvious ignorance since we were stuck with them!

For our safari, we were out in the park by 6 am until 11 am each morning. Then in the afternoons, we would return to the park at 4 pm and stay until the park closed at 8 pm. The best moment by far was when we were on our first night drive and had the chance to observe a mother lion and her three cubs. The mother was trying to hide the cubs in some bushes so that she could go out and hunt but the energetic cubs kept following her. She kept trying to stow them away much to their dismay which they expressed through defiant meows. I’m not sure what happened in the end since we left so as not to disrupt their routine! Also very exciting were the two male lions, supposedly brothers, that we got to see. I was surprised by the sheer arrogance and courage of the lions. They were fearless and although our jeep was parked in clear view and we were shining our lights on the animals, they were relentless in pursuing their path and made confident steps towards us, determined to go about their own business. In fact, both males decided to take a nap within 10 feet our car!

We also saw giraffes, zebras, elephants, spotted hyenas, monkeys, some very hungry hippos and a variety of colorful birds. Seeing the beauty and elegance of these animals in action is a true gift. It was also fun to observe the symbiotic relationship that the baboons and the impalas shared. These two groups of animals travel in packs so that they can warn each other about lurking predators. While baboons are able to climb up in trees and see what’s coming, the impalas have excellent night vision. At first glance this seems like an unlikely combination to benefit from each other but in fact baboons and impalas have much to gain from one another. These little intricacies found within nature continue to fascinate me. I’m not sure why but I find nature’s logic comforting and reassuring. Everything evolves in a specific way and while the purpose may not be obvious to an observer at first glance, the complexities are apparent for those directly involved and can be understood by others after some consideration.

On the morning of our departure from the Zambia, the elephants decided to make their way to our cabins. One elephant was grazing on the trees within the complex of our lodge. It was very entertaining to watch the elephants grab anything green in their path and then readily shove the stuff in their mouth! Saidi, our guide, told us that once upon a time, elephants had come to the dining area of the lodge during lunch hour and had carefully eaten everything off of each plate and out of every serving dish. Supposedly, the elephants had taken care not to break or even move any of the dishes but just eat every last morsel of food! Another funny story that Saidi told us involved a German tourist who began chasing a hippo around the lodge so that he could capture the hippo on film. However, the hippo wasn’t down for being photographed or hounded and he chased the tourist around, and then pushed him over. The tourist wasn’t physically injured but was psychologically traumatized and therefore headed back to Germany on the same day!

Luckily, we didn’t have to witness any foolish incidents on our safari. After getting some last minute photos of our heavy elephant friends, we wished them farewell and hit the road, headed back to Lilongwe.

Wednesday, June 6, 2007

The Light











The last few days have been a little hectic. I’ve been working in Lighthouse, a clinic that focuses solely on HIV/AIDS. The clinic sees roughly 200 patients per day and is very busy. They have a home based care component to their program that aims to address the healthcare needs of those patients who are immobile and not able to make it to clinic. So yesterday me and Danica, another med student, went out into the community with Agnes, one of the home based care nurses. Agnes has 60 patients that she sees each month. She goes to the neighborhoods of her patients on motorbike everyday with a backpack full of medications and some basic tools like stethoscopes and blood pressure cuffs. It’s definitely a tough job! And keep in mind, Agnes has her own family and is a mother of three!

Since I’m able to drive stick shift, yesterday we took one of the Subaru-like mom mobiles out into the community which made things a little easier. I managed to maneuver the mom mobile down dusty roads laden with potholes, craters and other surprises. Agnes, at one point, commented that she was impressed with my ability to maneuver the roads which means that I’ve picked up a new skill here!

The people in the communities that we visited were all very friendly and were extremely curious to see us. I was especially humored by one patient who asked me if I was Japanese! I thought that I practically looked Malawian after being in the African sun for five and half weeks and perfecting my tan but unfortunately, I guess that’s not the case! Groups of giggling children would shout “Azungu!” at me and Danica which literally means European but their general point was that we were outsiders or foreigners. As we walked from house to house within the community, we usually acquired a band of 15 – 20 children who would follow us and upon turning around or trying to communicate with them, they would quickly disappear, laughing and howling.

The communities that we visited were very rudimentary with houses made of brick, dirt floors, no electricity and no running water. The way home based care works is that a particular community has five to seven volunteers who identify folks within their community who need medical attention. Then once Agnes comes, she rounds up the volunteers, who do a brief song and dance to uplift everyone’s morale, then they are off to individual houses to see patients. Again, I must say that the work is very grueling. With the hot sun beating down on you, walking down these dusty roads and lugging along bags of medication is quite a task. But then to go from house to house and see one tough story after another is also quite demoralizing. Agnes, however, didn’t seems to be too disturbed as this is what she does everyday and she’s used to seeing these heartbreaking cases over and over again. This job definitely requires a fine balance between being tough and being compassionate. You have to care enough to keep on going but if you get too bogged down then nothing will be accomplished!

Here are some other thoughts that I had:
· Most households consisted largely of women taking care of each other. There just weren’t any men around (not that men were needed or could provide anything aside from what these women were already providing for each other….just and observation). One household in particular was a mother, her three HIV+ daughters and their own kids. The women had babies as they were working as prostitutes to earn money for food. Again, so many of these problems are manifestations of a breed poverty that most people couldn’t even imagine existed…..it is a violation of human rights that these people must live the way that they do.
· It was especially frustrating to walk through neighborhoods sometimes for 20 to thirty minutes then to find that the patient wasn’t home! It seemed like a waste of time but I suppose trying is the only option since there is no other mode of communication.
· I was amazed with Agnes’ patience. Western medicine is a little more abrupt and impersonal. Although we’re trained to build rapport with our patients I was surprised by the amount of time Agnes spent chatting with patients and other community members. Her role as a healthcare provider is important but more importantly, she’s a community builder and advocate. This role may be even more important and instrumental in stopping the plight of the HIV/AIDS and reaching not just individuals but villages, communities, cities, countries and furthermore, continents! Agnes sometime has to visit a patient 3 or 4 times before they feel comfortable revealing important information to her like their serostatus or any other pertinent issues.
· We were lucky to have a car yesterday so I could drive the volunteers and Agnes around but normally they manage by walking on foot since Agnes’ motorbike can’t transport volunteers. Sometimes the walking part takes forty five to fifty minutes!
· This is a different kind of medicine as most problems are treated empirically, you can’t test for specific bacteria thus you have to just load the patient one broad spectrum antibiotic and you never really know specifically what you’re treating. For example, I can’t count the number of patients who were given the following combination: Fansidar for malaria, metronidazole to cover a bacterial infection for GI complaints, paracetamol for fevers then ORS. This seems like a practical way to treat the most people in a resource poor area.
· For our lunch break, I had luckily packed a banana and peanut butter sandwich, an apple and some water but Agnes had a liquid concoction of crushed maize and milk in little box for 55 kwacha, about 38 cents. This is what she usually has for lunch if she has lunch at all.
· One of the ARV combination medications has to be refrigerated and it was interesting to see that even without refrigerators, the drugs could be stored in clay pots that kept them cool.

These are just some of my thoughts from this eye opening experience.

I also had a chance to visit an orphan project the other day which was also very touching and thought provoking. As I handed out construction paper, crayons and stickers, I was struck since the children didn’t really know what to do with the materials. They eventually began drawing random shapes and designs. One boy wanted to go home right away to tell his grandmother that he had gotten some new crayons. And as we left, the children sang some English songs for us that included “come back again and see you next time.” I’m not sure if they knew what it meant but it was very moving to be serenaded by a circle of 35 adorable little children! I wished that I could come back and give these children more. The contractor who is building a very basic school building said that it would take $10,000 for completion of the building and they’re still raising money for this. But just how much and exactly what would it take for these kids to be empowered and to lead happy, healthy lives and be in control of their own futures…..?

Well, this trip has certainly raised a lot of questions that I don’t have the answers to at the moment but one day, I hope that I will! As for now, I can’t believe that my time in Malawi is almost over! I feel lucky to have accumulated so many wonderful memories, friendships and to have encountered such a dedicated, intelligent group of individuals during my time here. I’m confident that these friendships and experiences will influence my future direction!

Tomorrow I’m headed to Zambia with Danica, another med student, for four days to go on a safari and I’m hoping to see some hungry hippos and other interesting flora and fauna! That’s all for now, hope this finds you well and see you soon!

Sima

Sunday, June 3, 2007

Ode to A Pineapple

Dusty roadside
Throngs of people passing by

I sit content
Voraciously consuming
This Cadbury milk chocolate bar with raisins

I rest in this blue fiat
Broke down with one tire gone flat
Yet I’m quite happy
On this Tuesday afternoon

And just ahead
Men chew on their sugarcane

And babies rest in comfort
Slung across the sturdy backs of their mothers

Secured by bright chitenges
Elephants, zebras, oranges and blues
The deepest of hues

Men walk by, making attempts to chat
In sheer wonder of my flat
Wearing green suits
That read “Pest Control”

But I sit content
Knowing the I’ve spent
My money on this chocolate candy bar
That’s now halfway devoured

And a man approaches me from a distant stand
Two pineapples in hand
Vibrant greens with a caramel body
Their sweet smells delighting my senses

No for now, Mr. Pineapple Man
And I carry on
Eating the Cadbury bar, enjoying the raisins
Enthralled by the crowds

So he walks away, the pineapple man

And the bustling market
Rages on
This man selling sea foam green trousers
That one selling fluorescent orange soap
Yet another one selling boxed perfumes

I’m still lost in my world of chocolate
Enjoying the moment

And the pineapple man
Approaches again

This time,
Willing to cut me a deal
That I now simply must seal --
40 kwachas for one pineapple

With my pineapple in hand
I feel lucky to be in this land
The land of Malawi

With bustling markets
People of colors so vibrant
Smiles so true
Plates of sima, curry and greens
Beats so light and free

And 40-kwacha pineapples!

Saturday, June 2, 2007

Ivy

Hey all,

I’ve been working at the Baylor Pediatrics clinic this week and it’s been quite an experience. It’s especially tough to see children having to live with so many complicated infections and illnesses. This is a poem that I wrote about one patient in particular, Ivy. She was HIV positive with a history of Tuberculosis and came in pretty sick this afternoon. She was supposed to wait for a slew of tests and as I was coming back to the clinic from lunch, I saw her and her mom sitting in the hot sun, drinking Fantas for lunch. As most of the patients here are very modest and humble, so were they. They didn’t want to accept any of my offers to get them some biscuits or other food items. Anyway, I think they got tired of waiting on test results and disappeared. They had taken a bus to get to clinic from a village that was 4 hours away, Ivy was very ill with fever, chills, cough and it was getting late. Luckily, Ivy tested negative for malaria and we had already given her antibiotics for the pneumonia that she most likely had.

Peach dress
Ruffles, lace, matching socks
And a pretty face.

Searching for clues
Piecing together the past
I try to make sense of this life – a child, a young girl
Staring inquisitively into my eyes.

This battered health passport
Is on its last leg.

Ivy. 7 year old female.
TB. Reactive.

Bright eyed hopeful,
Playfully poking and prodding
At my shiny, green stethoscope.

The chief complaint today
Is fever, shortness of breath,
Cough. Chills. Wasting.

Beautiful dark skin.
Arms intertwined with mom’s.

Right middle lobe crepitations
Forcefully make their way
from Ivy’s lungs to my ears.

Confusion, Bewilderment.
Smiles.
Does hope really live here?

Antibiotics. ARVs. Paracetamol. Chiponde.
Can you swallow all of that?

Xrays, Malaria parasite smears. FBC.
Tools to narrow the differential.

Ivy waits patiently. Wasted. Dusty road. Sweltering sun.
Orange Fanta is what’s for lunch.

Microscopes, stains and pains.
Ticking clock.
What will it be?

Gasping for breath, sweating.
Two beings embrace each other,
Holding fast while the sun sinks.

NPS. No parasites seen. NIS. No Ivy seen.
And the road ahead stands still.