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
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
1 comment:
hey sima - always wonderful to hear your stories. your mention of the dance and song reminded me of this quote, "Music and dance don't change policy, but they give people the joy and strength they need if they are to keep their struggles going in the face of repression, inertia, and despair." it's a really genuine sentiment, i think. it also means that we are due to get down when you return stateside! be well,
sara
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