My Favorite Photograph!

Hello everybody,

Thanks for following my blog, I’ve enjoyed your comments and feedback! I’m now back in Chapel Hill so I’ll be stowing my Malawi stories away in a special place until I can create more!

I’ll end with one last story to go along with my favorite picture. The story goes something like this. I had mostly given up any hopes of getting my little black duffle bag back since it was last traced in Frankfurt. The bag was in my thoughts regularly though, as the contents included tons of crayons for the little ones, my running shoes (which have great sentimental value as I learned how to do the moonwalk in these shoes during my breakdancing days in Austin), Trader Joe’s trail mix, girlscout cookies and chocolate. I told Innocent from the Tidziwe Center in Lilongwe about my missing bag and after he made a few phone calls, it magically appeared at the Lilongwe airport within days. I was pretty excited when I found out that the missing bag was no longer missing.

A nice gentleman from the Tidziwe Center drove me to the airport to get my bag. I was happy. I began eating cookies and chocolates from my bag at the airport. Then we got in the car to go home. On the way home, I spotted a young boy on the side of the road with a stick in his hand with things hanging off of the stick. When I asked the driver what the little boy was doing, the driver said, “You want more snack, something salty?” Excited about the prospects I excitedly answered, “Yeah, can we stop, I wanna see what that is!” To my surprise, dried, salted field mice had been strung across the stick. Young boys took this up as a livelihood. They spent their days catching field mice, dried them, salted them and then sold them to make money. So when we pulled over to check out this young fellow’s appetizers that were for sale, I gladly declined but handed him a box of girlscout cookies, which he gladly accepted. And that's how I came upon this lovely young lad, proudly displaying the product of his long hours in the field!

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.

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

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!

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.

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