insectivore

if only i were, then i would be in a gourmandary of delights. i write this in the glow only of the computer screen, as the power circuits will not support having the lights on inside at the same time as outside, or something. As a result i am sitting in an ever-thickening cloud of insects, despite cunningly distracting a good lot of them by pointing a torch at the oppsote wall.a large shiny one keeps getting in the way of the cursor here, a bit like a cat sitting on a newspapaer just when you are trying to read it.

sad news for the World Medical Fund - one of our two clinical officers is to leave us at the end of the week to work in the capital city, Lilongwe. This means more work for the remaining incumbent and that I am actually needed for my remaining few weeks here.

Tomorrow we go back to the government hospital, which i have come to dread, as - to use a well worn phrase describing such things -the conditions are appalling. it is not very clean, very overcrowded, very understaffed and hoplessly under-equippped (someone nicked the ultrasound scanner recently), the patients are really unwell with conditions that are never seen in England, as well as conditions well known to me but have developed so badly that they have become difficult to discern.

Dwangwa

Pecuniary concerns drove me north on Saturday, to a village called Dwangwa, which Mr Dezi had informed me had a bank that changed money and an ATM, but that I must get there by 10am before it closed. Dwangwa lies a mere 56km north of Nkhotakota, which I guessed would take about 30 minutes by car. Uncertain of the public transport however, I got up early and headed down to the middle of town. Sure enough, a bus sat by the side of the road, completely empty, while a fellow washed its headlights with a bucket and rag. A bit of wood with ‘Dwangwa Mzuzu’ scratched on it sat on the dashboard. I asked him what time the bus was due to go. Seven he said. Then he asked me the time. Seven thirty I said. He assured me we would go soon. I got on the bus, while he wandered over to the marketplace and disappeared. A fellow with shifty eyes followed me on and tried to convince me to go on the pickup parked just in front ‘because it won’t break down like bus’, and wouldn’t accept when I tried to inform him that the pickup was going to Thyolo and Mulanje (I had espied a bit of wood on its dashboard telling as such), and after standing in silence next to me for a while he also wandered off. I sat there for a bit longer. I wondered whether the pickup was really going to Thyolo. There being no sign of the first fellow (and therefore no imminent threat of the bus actually leaving) I got out and asked where the pickup was going. Dwangwa, a third fellow said, and only two hundred kwacha. I pointed to the sign saying Thyolo and it was removed hastily by the driver to hoots of laughter from the various people gathered about. How long would it take? About half an hour. I got in (the front seat, and aware of the privilege), and took in the appalling state of my transport. There were holes everywhere, the door wouldn’t shut and anyway there was no handle inside to open it with. I could barely see through the windscreen riven with cracks and clouded by a sticky-looking smear of beige I could not identify. By the time (it was some time, and still no sign of bus driver or indeed any passengers) we were receiving our push start and the engine coughed into life, I was planning my method of escape should our carriage drift uncontrollably towards a gulley or suddenly burst into flames. However our driver seemed fully aware of the vehicle’s shortcomings and drove not much faster than a gentle trot, slowing to walk at the start of any slope. This will take a long time, I thought. It took even longer than that, and after 80 minutes of holding the door shut, when I was beginning to wonder whether Dwangwa was a concept rather than an actual place, we entered some forest. Brachystegia is woodland of open canopy which used to dominate much of Malawi but has since much diminished due to a process a match factory owner in Blantyre once (rather impoliticly) called ‘natural thinning’ (sadly for many Malawians firewood is the only affordable fuel), but here in the Nkhotakota Reserve is in full glory. The dry season has brought many shades of brown and red into the treetops, making for beautiful views of the forest as we rounded hills. I dreamed we might see an elephant, and saw three baboons. A little later we passed a sign saying DWANGWA, which didn’t seem to demarcate any change in the consistency of the forest. The engine stopped and we drifted to a halt. Dwangwa, my seat-buddy stated, as we retrieved our personages from the intimacy of the last two hours, and unbent ourselves out of the cabin. No buildings. I walked for a bit and passed a bus stop, then some houses. A shout of ‘asungu’ went up amongst the children playing, which I took as a poor indicator of finding my metropolis with bustling financial centre. I passed a tractor, and came to a junction at a break in the trees, with a sign saying Bank pointing down a road. I looked down that road, which undulated straight over a wide plain of green sugarcane, all the way to the horizon, with no hint of a bank-like silhouette to comfort me. I wiped my forehead. I looked at my watch: 930 - nearly out of time. I looked at the road, and wondered whether running would make any difference. A white truck appeared, and stopped beside me. With a gentle hiss the door opened and a mist of cool air spilled gently out into the road. ‘Get in’ a voice intoned. I did. A few minutes later I was outside a large sugar refinery and the bank, which was in fact not one bank but two banks. One was quite empty, with a large dot-matrix sign flashing the latest exchange rates down into my money-minded eyes, and the other was full of long queues. I chose the empty bank. The young lady behind the counter politely informed me that they didn’t change money, and that I should go next door. She explained, when I protested, that the exchange rates were displayed because the bank hoped to offer that service ‘in the near future’. I hung my head and went to queue. Some time later, when the clerk had spent some minutes jiggling a wire in the back of his computer in order to ‘get the rates’, I walked outside, waist thickened by a wadge of kwachas. A boy on a bicycle offered to take me back to Dwangwa. I perched on cushion attached for the purpose and we wobbled off across the plain, through the thick air sweetened by the smell of the sugar cane and my relief at having the job done. After about 10 minutes of having my kidneys rattled on the pillion, we crossed the river Dwangwa bridge, passed the sign saying 'Beware Crocodiles' and came to rest at the side of the road. Dwangwa it turns out, despite my skepticism, is indeed an actual place, with a bustling high street and busy shops and stalls. The ‘God Is Able Shop’ and the Primary School whose motto was ‘Ignorance with Education' stood out, alongside long rows of cabbage and the bucket-maker.

The pickup home was newer and faster but no more comfortable, even though I had somehow been granted a front seat to share again, this time with a young woman. She asked me if I spoke Chichewa, and I had to say I do not. She told me with a note of reproach in her voice that Malawians do not speak English, they speak Chichewa. She is a single mother to a ten year old boy, and was going to Lilongwe (some 200km away from Dwangwa) to sell fish. She asked me jokingly if I wanted to adopt her son. I asked her how long she was going to be in Lilongwe. Back this evening she said, by six. I did wonder how realistic that assertion was, but did not express my doubts. Making a rather feeble attempt to carry the conversation further, I asked where her fish were, peering quizzically at her small blue handbag, and then reaching out to pat it as she gazed evenly back at me. In the back, she said.

Monday 20th November

I am back in the blogosphere, thanks to Mr Nkhoma generously lending me his laptop - although that was not the reason. Rather, I am supposed to be writing a plan for a study we will shortly be undertaking here at the World Medical Fund, on worm infections, with a view to possibly starting a treatment programme. I will do just that, once I have a bit of diarising off my chest.

Work today was quite tough, starting at 730 and not getting back from clinic until 230, without break. The clinic took some time to reach, being out in the marshland that fills the various depressions near the lake shore (this was once lake but has silted up over the millennia to form wet plains between rocky rises), and only accessible via dirt road. This is fine (if a bit bumpy) for the moment, but I am told access can be cut off during the rains, even for our powerful Landrovers. There was a high proportion of sick children today, mostly malaria, and the usual infections, rashes, poor nutrition. We worked sat on tiny school chairs at school desks, brushing the flies away from our noses, while the mothers patiently waited in the adjoining classroom, in the cacophony of screams and wails from their children. I saw my first case of suspected TB, in a seven year old who had been coughing for over six months, and had become very thin. Another little boy who’d been burned terribly in June came in wearing a headscarf. His mother peeled it off to reveal a black plate of dried stuff (ash?) covering almost the entire top of his head, through cracks in which green pus oozed and a sickly odour emanated. She was convinced the child was a victim of witchcraft, and had been applying traditional medicine, feeling too that hospital medicine had failed her child when he’d been in hospital. This was disheartening in more than one respect: that treatment had been incomplete (the chance of the child receiving the plastic surgery needed for his arms being small), that his mother might well be making things worse by applying poultices (of whose properties I can safely guess only one thing: not sterile), and that the very simplest treatment this child needed i.e. regular cleaning, dry sterile dressing and follow-up, was not available. We took three children back to the Boma hospital, a rather pathetic cluster of low buildings surrounded by pitted bare earth, two broken Toyota pickups, some trees sporting bright orange blossom and the odd goat. Various figures stood on the bare verandahs, or lolled on the floor, either patients or their relatives sheltering from the sun. Tomorrow I will find out more – I am to accompany Mr Chawinga (one of the WMF’s clinical officers) to observe a ward round.

In the afternoon I went to Farmer’s World and bought a bicycle. It is called ‘The Hunter’, the label stating reassuringly that it is ‘all steel’. It is a noble beast, having more moving parts than I could conceive – all rods and bearings – and special bent handlebars that mean you can’t pedal as you go around corners. It came with a pump, spanners, lock and a large mirror on a bendy thing that appears to have no actual means of attaching to the frame. Unfortunately the manufacturing process doesn’t involve tightening any nuts so it was unridable. On the advice of the proprietor I wheeled it around the back to a small bamboo shelter where two men took it from me and took it almost completely to bits and put it back together again in order to tighten it up. I confess I found the scene before me a delight, as with home-made tools, among a sea of broken and rusting bicycle bones, my wheels were dissected, spun and balanced, brakes adjusted, and seat squared. I was off, hefting my wobblesome steed up the road to have a look out over the evening plain. About a mile out of town a young man drew up beside me and told me he’d seen me at the repair shack and witnessed the hasty revision of the price from the initial MK350 to MK850, and that he was very sorry to see a stranger in his country treated that way. He is 17, and wants to be a doctor, and not in Malawi, because Malawians are greedy, although this was probably because they are very poor. We talked a bit about why many children get sick here, and how he might get into medical school. He asked me if I could be his mentor in that regard, and I said ok, though in my mind I doubt that drifting from school to university as I did will provide many gems of wisdom for him, who will have much tougher competition for a place.

Back at the base, my new acquisition received admiring coos and expert whacks on the tyres. Later, talking to Mr Chawinga about what I should do with the bicycle when I leave, he revealed that it cost about three times the security guards’ salary. Saving up for a bicycle on that would take almost as long as would me to save for a car in the UK. I began to feel a little embarrassed by my extravagance, which though useful, is not a necessity.

Please note that any patients mentioned will have had various details changed for confidentiality’s sake.

Nkhotakota

Day three in Africa. The first day I spent in a jeep with my new colleagues, watching the red and brown hills roll past and cyclists wobble gently from the middle of the road. I kept banging my head on the window every time i nodded off, to wake with a jolt, so tired I kept thinking the Chichewa my companions were speaking to each other was English. Then I went to bed, capable of little else. Yesterday was a more fulfilling, cooking my first meal, and having my first spider terror in the apartment. A particularly large and fast critter with huge claws and menacingly pale limbs skittered around my bedroom and yes, hid under the towel on the back of my door. Only once armed with a mop, bucket and copy of 'Quantum Physics for the Curious' ( I assume the very curious, because it is quite a substantial work), plus a large can of DOOM crammed into the back pocket did i have the courage to face the beastie. The battle was brief and I am sad to say a little one sided. It fough valiantly, claiming my left arm, which remained tightly in its grasp even as it died. It shall be stuffed and placed on the wall, where no doubt catching the corner of people's eye it will make them jump out of their skin. The arm might be a bit creepy too.

Charles, one of the security guards, kindly took me out on a walking tour of the town late in the afternoon. We trailed along dusty paths between numerous squat white churches with unfamiliar names ('The Brethren of Bible Breathers' stood out), trees with bright blossom, and wonky thatched houses. Mangoes are in season, preoccupying the children with either knocking the heavy fruits out of the tree with a well aimed stone or stick, or clambering about the branches, rattling them heavily to shake them loose. They would stop to yell 'Howah you?' and wave at us. There was a football match on in the shadow of the local station radio mast - we could hear the shouts of excotement some way off - where the pitch was marked out only by the line of spectators sitting obediantly on the ground. As we approached, the ball flew high into the sky, the crowd cheered and broke ranks, spilling onto the hallowed dust, only to be kept in line by a figure dressed in black with his matching sunhat pulled down so far on his head he had to crane backwards to se where he was going as he strutted the perimeter waving a cane menacingly.

Today we drove out into the (for want of a better word) interior, where I had my first clinic, in a tiny brick building with a tin roof. This was loaned to us by the local chief, who came to greet us warmly. A crowd of mothers squatted outside with their mostly very young children, partly shaded by an acacia tree, and waited patiently to be seen. Mr Dezi, the chef clinica officer kindly interpreted for me whilst seeing his own patients at the same time. The children were indeed ill, iller than would be the normal fare at a London A&E, and with more dangerous conditions, all of which i am not familiar with treating. Malaria seemed to nthe main culprit, exacerbated by poor nutrition. We treat any illness we see on the spot, though the diagnosis is largely presumptive. Only the sickest children will we take back with us to one of the local hospitals, where the mother has a choice between paying for decent care at the local mission hospital, or having next-to-nothing for free at the state institution. Feedback and followup for those remaining in the village is done by local volunteers who organise the day, and represent each village in the clinic catchment. While the volunteers do not make formal reprts (some are illiterate) they do know each mother well, and keep close track of the children's progress.
In a way what the WMF does is limited - we do not do blood tests beyond basic Haemoglobin levels, nor scan or xray our patients, and have only a partly-closed feedback loop, but simple interventions and health advice delivered on a regular basis, with thte possibility of inpatient care in dire need, can only improve the prospects for these children and ultimately their communities.

Tomorrow I will do the same at a different village, and then attend the antiretroviral clinic for children with HIV.

the adventures of Xeman

Please use magnifying glass.

time to go

a confusing evening yesterday at the Bethnal Green Working Men's Club Art Quiz. the camelhair trenchcoated quizmaster(against the backdrop of a giant broken 'heart' of pink lightbulbs) drilled us with questions such as 'what artist am i thinking of?', 'name three of the seven easy pieces', and 'the films of ingmar bergman: mostly a) horse b) bird or c) muffin?' (it is, incidentally, bird), plus a few easy ones such as what the range of HMS Belfast's guns is, and what they are pointed at (we didin't know the answer, obviously, because unlike the other questions it had nothing to do with Art).

Roman Imperialist Country Club: rocked my flat on Sunday, competing with the storm of fireworks in the surrounding streets for attention from the neighbours, but benefitting from the dry ice-like haze lying all around for glamour. New track pretty much done - must find way to post the recording... i smell MySpace upwind. More later.

Malawi: I am going there on Friday, so help me, with the World Medical Fund. Should you, dear reader, wish to help support them please visit their website (once the server is up and running again!), where I believe you will find details about donation!
Go to!