Final week in Mulanje

It was great to return to male ward for my last week, although it was hard to believe it was in fact my last week. Loved being back with the dream team of Cecilia, George and Major. Having been at the hospital for almost six weeks I really felt part of the team. It was an fantastic experience for me to be able to work independently and continue developing the skills I had learnt since being at MMH. As with female ward, we were a nurse down in my last week so it was just me and Cecilia - my nursing mentor - and as a result we were kept busy and the week soon flew by and before I knew it I was on duty for the last time.

I couldn't of asked for a better nursing mentor than Cecilia. Despite me being seven years older than her, not to mention double her height, she took me under her wing from day one and made me feel so welcome on Male Ward. Both Cecilia and George took so much time to teach me and make me feel part of the male ward family.

Cecilia, George and I - Dream Team

Some gifts for Cecilia and Male Ward

I was so sad to finish my placement at MMH and there were some tears shed when Cecilia and I exchanges gifts, signed off all my assessment documents and said goodbye.

Gifts from Cece

After finishing up our shifts on Friday, we still had our final HIV/AIDs workshop the following morning. This was the fourth and final workshop in series and the kids didn't let us down by turning up in large numbers again. As this was our last week, we decided to run an activity that would bring all the information we had discussed in previous weeks together. To do this, we split the participants into smaller groups and gave them the best part of an hour to create a role play that would demonstrate their knowledge. As usual, everyone got involved and the plays were amazing. The highlight had the group who including a post-sex celebratory dance. After watching all the plays, the group as a whole voted for their winner and then it was time for some photos, goodbyes and some dancing for the last time.

It has to be said that we couldn't have done these workshops had it not been for the help of Juliana and Peter, two student nurses from the hospitals's nursing college. So after the last workshop, it was time to take them out for lunch and thank them for all their hard work. 

Thankyou Pizza and our last meal at Mulanje Pepper

Marmite, elephants and a sex change.

Following on from my last post, thankfully my weekend wasn't totally scuppered by ditch gate. Our original plan had been to get ourselves up the 3001m of Mount Mulanje (aka known as Mulanje Massif....aptly named). However, after my incident I thought it wise to avoid any sort of walking/climbing considering I am clearly unable to walk along a flat road without injuring myself.

As usual, we held our HIV/AIDs education workshop on Saturday and fortunately for us, people actually decided to come back and they were only half an hour late this week, in fact, we had more people than the first week. We split the larger group up and asked each group to design a poster that could raise awareness about HIV/AIDs or STIs transmission and prevention for their peers. As you can imagine we had some very interesting pictures by the end! Each group presented their poster to the rest of the group and the group as a whole decided who had designed the best poster. Fortunately (for everyone!) I didn't have to dance this week.

Action shot

We had an early start on Sunday as instead of scrambling up a mountain we had managed to cadge a lift with one of the doctors and medical students down to Majete National Park. After a fairly bumpy 2 hour drive we arrived. Having been in Africa for several weeks now, it was my first chance to see some animals other than chickens and monkeys. Before we knew it we had spotted some Pumbas (no Timones though. Although, what kind of animal is Timone anyway? answers on the back of a postcard please). Speaking of which, I have written postcards but getting stamps round here is no mean feat!.....Anyway, I digress.....After a wee drive through the game park we parked up at a small hide thingybobby to have breakfast. Breakfast is always a highlight for me, no matter where I am, but sitting eating breakfast on a Sunday morning, looking out at the hippos wallowing in the Shire river definitely took the biscuit, especially as someone had the foresight to pack marmite into the picnic. So happy...as you can see below.

Happy face!

Slow day on safari!

As our food went down, we headed out for some more early morning animal spotting and pretty quickly found ourselves being charged at by a particularly angry looking elephant. Fortunately, I wasn't driving (otherwise I would have stalled at least 3 times, had a melt down and got out the car) and we made a swift get away.


After that little adrenaline boost, things took a slightly more calmer turn as we settled down at another of the look out points. However, it was a slow day down at the watering hole and after the early start, a nap was much more appealing to the others.

Some slightly calmer elephants than the one we encountered after breakfast.

Pool overlooking the Shire river.

We finished our day trip with a wee dip in the most incredible swimming pool, in a lodge just near the park. As with our breakfast spot, the pool looked out over the Shire river and it was the perfect way to end a day of safari.

Back to the wards on Tuesday and I had a slight change of scenery (or more precisely, a change of sex - not me of course) when I was allocated to the female ward. I had been hearing over the past few weeks that female ward had been pretty quiet so I was looking forward to a restful week. I couldn't have been more wrong as they were one nurse down so it was only me and one other nurse for the ward. It was great to a chance to put all the new stuff I have learnt into practice on a different ward though. It feels great now I am past that awkward settling in phase and I can just get stuck in, work independently and actually be useful.
I think I have said this before, but I can't express how amazing the other staff, especially the nurses, have been here. They have taught me so much and although I miss home, I will be sad to say goodbye to them when the time comes.

Dressings, dance offs and ditches.

 Another week in male ward done, time is really started to fly now. My week started off very busy. I arrived back on the ward on Tuesday morning after my days off to find the ward full due to a bad road traffic accident during the weekend. The patients all belonged to a football team who had been travelling home from a match. They all had really nasty wounds which took all morning to clean and dress. I definitely earned my lunch that day. In between getting their wounds seen to,  they spent all day sat outside in the sun (a perk of a Malawian hospital) waiting to be discharged home.

After the last football player had packed up his things, settled his bill and rounded up all his family, the ward felt empty. A theme that lasted the rest of the week, with regular discharges but very few admissions. On Thursday and Friday we had a grand total of 4 patients!! With two nurses and myself, it was practically 1:1 care, apart from they were all stable and needed very little attention! A massive contrast from earlier in the week. 

Peter, Hemy, Me (aka peg leg) and Juliana before our first workshop.

As well as working my shifts on the wards, myself and Hemy are also running some HIV education workshops in the local youth centre. We were granted funding from the Magnus Magnussun Fund, through uni, which allowed us to set these up. We have done two sessions so far and are planning another two before we leave. Luckily, we have enlisted the help of another two student nurses from the hospital's college to help us. Despite not quite knowing who would turn up and what to expect, the first workshop was a huge success (eventually). I say eventually, because being due to start at 9am in the morning, Hemy and I rocked up at 8.30 to make some final preparations. But after being in Africa for a few weeks, we should have known things would run no 'African time'. We sat waiting patiently from 9am until 10am and we had a total head count of 1! It took another half an hour for more and more people to arrive and we started the workshop sometime around half 10, 11ish with over 50 people - ages ranging from 7 to 20ish. Everyone participated in the activities we had organised and we finished off the session the only way you can finish anything in Malawi.....a lot of loud music and more dancing. As per usual, my dancing skills weren't quite up to scratch and I was well and truly outshone by the children. It did get slightly awkward though when the kids started to copy all my dance moves, so I think at one point I had about 20 children under the age of 10 all changing the light bulbs. It was such a good morning though and great to see our hard work in action after months of planning.

Doing my best colouring in

Our resident workshop DJs

Friday night at Mulanje Mission Hospital is pizza night. The nearest town -Chitakale, is home to (apparently) the 'world's greatest pizza' and after a few weeks of eating my body weight in peanut butter, rice and nsima, I'm starting to agree wholeheartedly with them. Normally these Friday nights are pretty standard......couple beers, pizza then home. Last Friday was a different story though. Before settling down to an evening of pizza goodness I nipped over to the cash machine. As per the norm, the first two banks I tried were either empty, broken or my card had been blocked (RBS don't like people using their cards in strange places and seem intent on blocking it every time I go away......but dont get me started on RBS!). So, off I troop (with Hemy as my bouncer) up to the next bank at the other end of the street. As it was half 6 or so in the evening, it was totally pitch black - and I'm gonna blame the darkness for what happened next. Walking along quite the thing (while cursing RBS), I managed to miss the massive gaping ditch that runs along the side of the road. The next thing I know I'm up to my thighs in a minging brown mud/water/rubbish/god knows what! I clambered out to be met with Hemy's look of 'is she hurt or is it ok to laugh' face and about twenty Malawians running across the road to my aid. They proceeded to make sure I was still functioning by testing all my limbs, bending them back and forward really fast. Luckily I hadn't broken any bones, but if I had I'm not sure that would have been the best first aid! We finally managed to shake off the concerned Malawians, pick up all my things and trudged back to the pizza place. I didn't fancy walking in like the creature from the deep so I sent Hemy in to discreetly tell Clare, the designated driver for the evening, what had happened. I in the meantime stood outside, dripping wet, inspecting my wounds. And, of course, weeping like a baby :(

After cleaning and dressing my wounds (luckily I was now an expert after taking care of all the football players injuries earlier in the week), changing my clothes - which were covered in the contents of the ditch,
and drying my eyes, I headed back for the now much needed pizza and beer. My injuries weren't too bad, the worst one was from knocking my elbow off the side of the road on my descent into the ditch ('descent' makes it sound graceful; it wasn't graceful!). So, I have a lovely multicoloured bruise and some attractive scabs.

You'll be pleased to hear that later that weekend I was able to successfully withdraw money without doing myself any more mischief!

Returning to the scene of the crime. Of course, the ditch is now dry!

Some ramblings from Malawi - mostly about minibuses

So, my time here is fairly flying by now. I feel totally settled in to the routine and ways of working on male ward and learning so much every day.

After a busy week on the ward last week, we spent our couple days off duty up in Blantyre. In order to get there we have cram ourselves and our bags into the minibuses that run through Mulanje up to Blantyre. This wouldn't be a problem were it not for the other 27 or so other people (and chickens - usually live!) who also want to be crammed into the same minibus. However, this is no problem for the Malawians! The first time one pulled up, I very politely said to the 'conductor' that because the bus was full I would wait for the next one. This was met with a look of disbelief before herding Hemy and I in between the other passengers. Put it this way, in future, my morning commute on the Glasgow underground, squashed under some guys armpit, will feel more than spacious! If you haven't lost circulation to at least one of your bum cheeks and don't have the beginnings of a pressure ulcer by the time you get to your destination, things are going well!!After being 'seated' on the minibus, my next concern was how we would actually manage the 40km or so journey considering every single warning light on the dashboard was lit up and the petrol gauge was way below empty! But, despite not stopping once to put any petrol in, we somehow made it. Maybe turning off the engine while going down hill helped......might try this the next time I'm going downhill in the golden bullet.

A view over Blantyre.

Despite all this, we made it to Blantyre.

Blantyre itself is pretty standard. But, after being in them middle of the nowhere for a  couple of weeks, arriving in the hustle and bustle (and paved streets!!!) of Blantyre made me realise how much of I city girl I am now! The one thing I didn't count on when arriving in the city was to come face to face with the biggest spiders I have ever seen (not that was plural, not singular spider!). Mulanje has its fair share of wee beasties but these were on a totally different scale. I was even slightly concerned for the wee cat, sleeping peacefully below the massive spiders webs, I'm prettry sure they would devour the poor wee thing for a mid morning snack! See photo evidence below.

As Saturday night approached, we were looking forward to finding a nice bar in town, getting some food and relaxing after our busy weeks. But all the 6am wake up calls were obviously taking their toll and after a few beers and a curry (yes, curry! It was sooooo good!) we were ready for bed. I think actually we were tucked up in bed for 9pm that night. Poor effort I know.

After our 'big night on the tiles' it was soon time to squeeze back on to the death mobile back to Mulanje in time for our shifts on Monday morning. Unfortunately we were so busy playing the game of human tetris in the the minibus to realise we had boarded the scenic route bus, added a nice 30km to our journey. This on top of the hlaf hour stop in some random town while the driver had his tea. We made it home just as it was getting dark.

Nalice preparing our dinner

Back on duty on Monday morning was a slight shock to the system after our weekend away, but it turned out to be another good week. One of the nurses form Hemy's ward invited us over for tea one night, and not one to turn down a hot meal, I was there in a flash. Nalice (the nurse) showed us how to make the Malawian staple, nsmima, on her chakoban (no idea how to spell it). Its basically a charcoal based cooker thing on three legs which doesn't look to dissimilar from a cauldron. She prepared the nsima, an egg and tomato relish and some veg. After taking a tiny portion for herself, she proceeded to pile the food on to our plates. I'm not known for my small appetite so I was happy to tackle the huge portion with gusto. I was, however, defeated and actually think my stomach has stretched to a point of no return as since then, nothing I eat seems to fill the black hole! The food was delicious though.

This week also saw the introduction of a new animal to our commute. Last time I wrote about our daily walk past all the chickens and their endless trail of chicks. This wee though, we were met at the hospital gets by a whole gang of monkeys. Not something I would normally see on my way to work/uni in Glasgow.

Nsima action shot

New addition to the morning commute

Best weapon ever!

I think I mentioned before about our security guard. Anyway, he arrives every evening at 6pm and keeps us safe and sound until 6am the next day. He goes above and beyond his security guard duties though, and unlike some people I know, isn't shy to some domestic pastimes. For example, every morning usually around 4am, he starts his daily sweeping. Its actually quite a soothing soundtrack at that time in the morning and we always wake up to a leaf free garden. Plus the sweeping noise is a massive improvement on the racket he made on our first few nights. Maybe it was some sort of 'Welcom to Malawi' thing, but I'm not convinced tapped loudly on the outside wall to your bedroom is that welcoming. I also wasn't impressed when he started chapping my window at half 5 in the morning, although I think he was just letting us know that was him off. He does do a grand job though and I'm always interested to see what weapon he will leave behind each morning. He started off with a good old machete - a pretty standard weapon for the modern day security guard, But now he is gone old school, and the other morning I found this beauty on the porch. I'm thinking ti would just be rude not to crack open my best Maid Marion impression.  

On duty - first full week on the wards

So, you may reading back my posts it might seem as though its all play and no work? Well, I hope to rectify  that in this post. We are working our Scottish/English bums off out here! The current shift pattern is 7am - 5pm and we are doing about 40hours per week. The early start is made slightly easier when your commute to work is a short work from the house and nine times out of ten its a beautiful morning (makes a change from horizontal rain and subway body odour). The walk to work also involves a daily jaunt past all (to many to count) chickens with their extremely cute chicks following close behind.

So, we get to the ward just before 7 for the handover from the night staff before going to the morning report with all the other wards. This being Africa, the morning report is due to start at 7.15am and there is always people still drifting in after half past, not to mention the groups of chattering women stood right outside, or the people randomly singing. All in all, it makes listening to the report, near impossible. If anyone looks over at me during the report, I'm sure all they would see is my scrunched up face, eyes closed, slightly confused  - although nothing new there - face.

After report, we finally get to work and we find out what kind of day we are going to have.

I'm working on the male ward just now. It has its peaks and troughs, with some days being very quiet and other days you don't sit down for the 10 hours you are on duty. Its totally different from any NHS ward I have ever experienced and the nurses role here is quite different, which is taking some time to get used to.  A big difference is the patient contact. All the patients have a self appointed 'guardian' who takes care of all the personal care, feeding  - many of the tasks that a nurse or health care assistant would do in the UK. However, this is probably a good thing for me and the patients here as my chichewa (local language) is still a bit rusty, so my banter only stretches to "good morning" "how are you" "pain?" - so, very limited!

Despite having less to do in terms of personal care, the ward can sometimes be very busy. We often get numerous admissions all at once and it can be quite stressful running around trying to find all the equipment you need. The patient often comes in with many family members, so it can be a tight squeeze in the treatment room with all these people, the nurses, the clinicians and me battling for a space. Also, as in the UK, the men wait until the very last possible moment before seeking medical help and so they are often very sick. However, the staff here do everything they can for each and every patient in order to get good outcomes.

I'm learning so much being here and the staff on the ward are great teachers. And the patients are very accommodating of my dodgy language skills!

Here are some equally dodgy photos of me on duty in the male ward.

Cecilia, George and I receiving a very Malawian gift of sweet potatoes from a patient being discharged.

Male ward

Looking a bit worse for wear! Note...the pregnant belly is actually two pocket fulls of gloves and hand gel

The view across to female ward from the duty room in male ward.

Exploring, chico time, bike taxis and baking

After our first few days settling in at the hospital we had a chance to take some time off and explore Mulanje district. On Saturday we headed down through the tea fields towards the nearest town, Chitakale. What should of taken 45mins turned into an hour and a half trek! Thankfully, a teacher from one of the local primary schools took pity on the two slightly sweaty mazunga's and showed us the rest of the way. You can see from the photo I was pretty happy the walk was over! He was telling us he teachings over 160 children at one time! I also taught him how to say "haud yer wheesht".....though it might come in handy when he wants peace and quiet during his next lesson.

Chico time

Getting home from Chitakale was much quicker thanks to the bike taxis. Its basically a glorified backy, but the person receiving the backy (that sounds wrong, but you know what I mean) has a cushioned seat, footrests and a handle bars. I did feel sorry for my driver as he had not only my weight, but the weight of all my shopping! It was also slightly embarrassing when we were practically overtaken by people on foot when going up hill. But, we made it and I managed to squeeze in a photo (excuse the expression). And only took 15mins to get back to the hospital and cost MK200 which is around 40p.

No hands!

A view from the bike taxi

We got back to Mulanje Mission just in time to watch the second half of the local football. We had seen the team leave from  Chitakale earlier in the day, with all the players in their strips, sat in a big trailer with their logo, pulled by a tractor. We were supporting the red team, but unfortunately i wasn't following the game that closely and I have no idea of the score.

After out busy Saturday exploring around and about Mulanje Mission, we had a quiet day in the house getting ready for another week on the wards. This included washing all my clothes by hand and then having to iron them!!!! We need to iron our clothes here as when they are hanging to dry, some wee beastie lays eggs on them and the next time you wear them, they burrow in to your skin. Nice. So to kill them you need to iron them. Whilst in the domestic mood, we also tried our hand at bread making (thanks to my Gran's recipe) and the results weren't too shabby as you can see.

So that was our first weekend in Mulanje . A bit of exploring, a bit of getting lost and some domestic goddessness.

In the beginning...

So its been a week since we left the homeland and its been an interesting and challenging week for a whole load of reasons. The journey from Glasgow was comparable to the journey to middle earth. It went on forever and ever!!! In total we managed four flights and six take offs and landings - this is because in Africa, they run planes like buses, so you end up stopping off at random airports to let people off and more people on! The journey was also delayed slight due to the arrival of none other than President Obama at Tanzania's Dar es Salaam airport, inconveniently, just as we were about to make our approach. As a result, we ended up going round in circles over Zanzibar for a good half hour, until finally we could land. Needless to say we didn't get the same VIP treatment as the president. There was no red carpet and it took the best part of two hours to get through immigration. We definitely new we had arrived in Africa and it didn't take long the the phrase TIA (This is Africa) to be banded  about. We were in no rush though, as we had about ten hours to wait until our next flight. For anyone wondering....there is NOTHING to do at Dar airport. NOTHING!
This is us half way through the mammoth journey, about to board the flight to Addis in Ethipia. Which you might notice is the biggest double back on yourself in the history of double backing (Glasgow-Dubai-Dar Es Salamm - Addis - Blantyre). I can now say that after all these flights and takings off etc, I am well and truly over my fear of flying.

Anyway, we finally made it to Blantyre and a short drive later we were pulling into Mulanje Mission Hospital. Typically, it was pitch black as we arrived so we had to wait until the next day to actually see where we had landed and there was not much else to do but enjoy the novelty of a bed and recover from the 48hr journey.

We are staying in a small guest house on the mission site which has everything we need, incuding our very own rape gate (charming) and don't need, including lots of lovely spiders and other beasties. Its cosy though and we even have a wee garden that we share we all the local chickens, dogs, cats, monkeys, butterflies....its basically a poor mans Edinburgh Zoo.

Just a short walk from our house, you'll find yourself at the edge of miles and miles and miles or tea fields. its basically my dream location, if only I knew how to get the leaves into something drinkable. Towering over the tea fields, is the regions biggest attraction....Mt. Mulanje, or the Island in the Sky, which we plan on exploring on our weekends off.

After catching up on our sleep and getting our tour of the hospital, it was time to experience our first Malawian party. The party was to mark the departure of one of the British Drs who has been working at the hospital since Sept. It was a chance also for us to meet all the staff and other students etc. Not to mention a chance to try the infamous Nsima (google it) and to throw some shapes (Malawian style). With no alcohol at the party, I was concerned my dancing wound suffer, but from the photo evidence , there was no need to worry!!

The morning after the party was our first day on the wards. A 7am start was a bit hard to bear but we managed. Within no time I had been introduced to the Male ward at the hospital and set to work with the other nurses. Its always hard starting in a new ward, and this was no exception. It was definitely a shock to the senses and was the complete polar opposite to any thing I had ever experienced. My first morning on the ward was manic helping to care for an acutely ill patient. Apparently, Malawian men are quite similar to British men in that most of them wait until the very last minute before seeking medical attention. As a result, a lot of the patients on the male ward are very unwell. Despite this, the afternoon was much quieter and it gave me a chance for the Malawian student nurses to teach me some Chichewa. In return I taught them some useful Scottish phrases such as haud yer weesht which is easier said than done!

Anyway, I think that will do for now. Its already pitch black here (6:30pm) and our security guard will be gettign his knickers in a twist if we don't show face soon.

I'll hopefully be able to resume this tomorrow (internet connection depending).

Tionana
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