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.