What is Your Name?

What. Is. Your. Name. The children in Malawi have punched these words at us for weeks. Today, we were able to return the favor. Yet, instead of asking for a person’s name, we tried to discover the name of the illusive ankle joint.

It started when we were attempting to finish booklets for the Community Health Workers. Our colleague, Alex, had finished all of the translation, except for the page on ankle range of motion. Dr. Nesbit and I thought this would be a quick fix. We planned to ask a nurse or a ward worker for a quick translation of the word “ankle,” thinking it would take no time at all. We were wrong.

This is how the search for the Chichewa translation of ankle joint began. It was almost a 24 hour process. We searched high and low, asking nurses, clinical officers, ward workers, patients, and even the local Father. No one knew the translation. The search for the ankle joint spread like wildfire throughout the hospital. Everyone wanted to help, but no one could find the answer. After hearing from a clinical officer that the Chichewa word for ankle was “kakolo,” we thought we were in the clear.

Yet, then we went to the Community Health Workers’ monthly meeting, and again discovered we had been politely misinformed. The word “kakolo” actually meant tendon, not ankle. It was quite a goose chase, yet full of laughter and collaboration. The meeting with the Community Health Workers was still a success, even though no one knew the word for ankle. We surveyed the volunteers and discovered that, after only 2 weeks, they had already been implementing physiotherapy skills in their patient care and guardian training. So, though there may not be a reliable word for “ankle” in Chichewa, we see that our volunteers are reliably and wholeheartedly serving the local community. And that is just fine with us.

Community Health Workers gathered for the monthly meeting.

Community Health Workers gathered for the monthly meeting.

Volunteers pictured reviewing the monthly report.

Volunteers pictured reviewing the monthly report.

Alex and Carolyn observing the volunteers.

Alex and Carolyn observing the volunteers.

Volunteers answer the survey of physiotherapy skills.

Volunteers answer the survey of physiotherapy skills.

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The Art of Sharing

During our time in Malawi, we have learned a little of their craft, the art of sharing. This giving and receiving relationship has been a theme throughout our stay. Yet, it seems that though we came with ideas and skills to share, we received far more from the people here. We were taught lessons in hospitality, joy, laughter, and greeting. It has been such a pleasure to learn from the Malawians. This week we have experienced both roles, giver and receiver. As a giver, we were able to provide a patient with shoes to protect her feet. Pictured below is our patient’s first walk in her new Nike Frees. Her face beamed as she shuffled to test them out on the hospital grounds. As a receiver, we were treated to afternoon tea at the nuns’ convent. The nuns shared with us their sodas, donuts, and tales of life in Malawi. We were overwhelmed by their hospitality and generosity, sharing their stories and their holiday treats. We know that as we return to the States, we will reflect on what Malawi has taught us and discover more how it has changed us. Tomorrow morning, Elisa and Kristen will return to their family and friends to share their experiences with you. We hope you will learn something from Malawi as they tell their stories.
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Comfort Food

Today we were treated to a traditional Malawian meal cooked by Comfort, one of the nurses at the hospital. She opened her home to us and showed us how she prepared the meal, allowing us to try various parts of the process. Shown below is Carolyn watching carefully as Comfort stirs the nsima, which is made from corn flour and water. There is a special way to mix the nsima which Comfort made look very simple, but after trying it, we realized that it was much more difficult than it looked. As we sat down to eat, Comfort poured water for each of us to wash our hands, as Malawian meals are typically eaten with hands rather than utensils. She taught us how to roll the nsima in our hand and how to use it to pick up the sides that accompanied it, such as beans, cabbage, and pumpkin leaf. It was all delicious and we were all left very satisfied. We are thankful that she welcomed us into her home and shared with us a piece of her Malawian culture.

 

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Joy amidst Hardship

Our experience thus far in Malawi has been a rewarding one, however we have learned many lessons and faced hardships along the way.  A patient we have been working with closely is facing a progressive neurological condition that has left her unable to live independently and take care of her family.  The first encounter we had with her she appeared to be very sick and sad about being in the hospital, away from her home and family.  Each day we accomplish more and more with her and the joy she expresses through each task completed is very rewarding for us.  Each patient in the hospital is required to have a caregiver with them to take care of daily necessities such as bathing and cooking.  Since many of these patients share rooms with one another, that space is turned into a small community consisting of the patients, caregivers, and healthcare providers all with the common goal of getting their family member home.

Yesterday started off as a challenging day as we all were exposed to the reality of severe malnutrition and it’s effect on a child and her family.  Malnutrition is a reality in Malawi faced by many people in the community so much that in the pediatric ward there is a section dedicated to malnutrition.  This ward focuses on putting the children on a feeding plan and getting them back to their optimal nutritional level.  One of the aspects that we found was most challenging is the length of time it takes before a child is admitted to the hospital whether it be a lack of resources or a gap in understanding.  It is obvious that all of the mothers love their children and their condition is not a reflection of their inability to provide proper nutrition.

Despite the many challenges faced in this Malawian community, the people and the culture here is so positive that they not only bring joy to themselves but all of the people around them including us.  Pictured below are some of the patient’s caregivers, who enjoyed teaching us some of the common greetings.  It is refreshing to hear laughter knowing how much these families go through on a daily basis.

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Moving Around Somewhere

We took a leisurely walk on Sunday afternoon in the hot Malawian sun. Along the way we ran into a group of women. We chatted with the ladies in broken Chichewa-English, and sang local songs with them. The leader of the troupe asked us if were were going to the village or just “moving around somewhere.” Yes, we were moving around somewhere (taking a walk).

The beginning of this week has been full of “moving around somewhere.” We walk around the hospital unsure of what to expect. For a moment we might think we’ll have a laid back afternoon, and then a nurse says she has a patient that needs physiotherapy. On Monday we were helping a patient with proximal muscle weakness walk back to her room, and we were interrupted by a pediatric patient’s mother who wanted us to resize her AFOs. Carolyn rushed to the guesthouse to retrieve her blowdryer (which had yet to be used), while the rest of the team finished walking with the patient. It was a team effort to remold the AFOs. Kristen and Casey manned the blowdryer, while Carolyn and Elisa held the AFOs in place. We’ve been thankful to use so much knowledge from our schooling. From Cardiopulmonary to Prosthetics & Orthotics, from Neuromuscular PT to Musculoskeletal PT, no class nor bit of knowledge has been untouched. Just as we have become a team here in Malawi, uniting our skills and strengths, so we have integrated our knowledge, melding the knowledge together to help our patients and to grow as clinicians.

Last night we decided to “move around somewhere” to look for more souvenirs and enjoy the cool night air. Though we may be busy, or “energetic,” as our colleague Alex likes to say, we try to spend some moments enjoying the beauty of Malawi. We wanted to share a picture of an African sunset, so you can enjoy a gaze at our backyard in Malawi.

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Weekend Adventures

After two busy days in the hospital, we finally had a chance to go exploring. We followed up with our Friday patients on Saturday morning and headed off to Lilongwe. To get there we took a bike taxi in the rain to Namitete, a nearby town, where we packed into a mini bus ranging from 20 to 26 passengers at a time (can you find Kristen in the picture below?). After an hour of traveling, we arrived in Lilongwe ready for shopping and bartering for souvenirs. At one point, we had to cross from one side of the market to the other using the man made bridge pictured below. We were able to enjoy a nice lunch at a restaurant where we sat outside listening to Santa at the nearby bounce house. At the grocery store, we stocked up on food before heading back to our village, Namitondo. When we reached the bike taxi again, the sun had come out and it was a beautiful ride home. We returned to find that there had been no power in the house today so it was good that we were out exploring. The power outage lasted two days. Sunday we were able to enjoy a nice long nature walk before lounging around reading and playing cards. The power returned just in time to make dinner. After resting up today, we are ready to head back to the hospital tomorrow morning to continue making progress with our patients.
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Village Home Visits

On the final day of training, the volunteers were split up into two groups to travel to the villages and visit a community patient.  The first group, led by Carolyn and Elisa, helped a patient presenting with unilateral weakness. The second group, led by Dr. Nesbit and Kristen, assisted a patient with lower extremity paralysis. The volunteers were able and eager to apply their knowledge of physical therapy with assistance from the physical therapy students. We were so proud that they were sharing their skills with the patient and caregivers and independently documenting the visit. Also, we were surprised by how many people could fit into a small room for treatment. As you can see in the picture below, Carolyn and Elisa were squished into a small room with 20 people, including volunteers and family (only half are viewed in the picture). Though the students may have felt crammed, the Malawians showed no indication of claustrophobia as we shuffled around the room while walking with the patient. The highlights of the last day of training were being able to help the patients and their families and to see the volunteers proudly use and share their skills.  The question for the future is…what next?  Will the community health workers continue to apply the physiotherapy skills they learned in training in their villages?  How will we be able to spread home-based physiotherapy throughout Malawi in a sustainable fashion?  This is the first of hopefully many physiotherapy trainings for palliative care throughout this country. Pictured below are the first volunteers to receive a certificate for training in physiotherapy for palliative care.

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Training the Trainer

On the second day of training we had the privilege of “training the trainer.” The volunteers learned 22 physical therapy skills to take to their villages. The skills were divided into the 4 focuses of physiotherapy: prevention, recovery, movement, and comfort (these are pictured below). To assess their skills, we performed a competency check off. This will ensure that they are able to perform and teach each skill safely and accurately to patients and their families. On the third day of training these volunteers will demonstrate their knowledge by serving a community patient in the village. As the hands do, the mind remembers.

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Training Day no. 1

Today was filled with teaching, learning, singing, dancing, and a whole lot of laughter. The Malawian Community Health Workers bring joy to learning through their interactive and social learning style. The day started by greeting Community Health Workers who traveled miles by foot to learn about physiotherapy approaches to palliative care. These workers volunteer their time and services to help their villages and those with chronic or life-threatening diseases.

The highlight of the day was teaching the volunteers physiotherapy skills, such as cane walking and bed mobility. It was team approach. Elisa was a fantastic patient letting the volunteers practice their skills. Kristen acted as the physical therapist in demonstrations, helping correct form. Carolyn presented the material from the powerpoint, working alongside Alex, the Home Based Care Nurse Trainer, who translated the presentation. It was a mixture of culture working together in order to help the community. As a “Thank You” or “Zikomo” for our presentation, the volunteers sang (and we danced) in harmony.

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Welcome to St. Gabriel’s Hospital

To our surprise, the sun came up at 5 and the roosters started crowing so we decided to start our morning early. We first attended a meeting with the medical staff at St. Gabriel’s Hospital to discuss the statistics and important information for each ward. After taking a tour of the hospital, we were then introduced to the Palliative Care unit where we attended rounds. We were able to help evaluate two patients and the doctor and nurse both valued our opinion in terms of what the patient’s underlying issues were and what things they could do to get better. We helped to get a patient out of bed and walk to assess his functional level post-stroke. The medical staff seemed very well trained and educated about general medicine, but as far as Physical Therapy, their knowledge was limited. Aside from a language barrier, the thing we found most difficult was tracking the sequence of events that led to the patient’s condition. They tended to tell parts of the story in no particular order which made it more challenging to evaluate.

We had a long break so we explored to the nearby areas such as the school and church. We ran into a lot of kids that were excited to see white people, or as they like to call us, “azungus”. They followed us asking us to take pictures of them so they could see themselves (as you can see below). In the afternoon, we prepared for our training session of the Community Health Workers that we will be presenting over the next three days. The Director of National Palliative Care Association of Malawi and the Home Based Care Coordinator of Lilongwe will be attending to observe and learn about physical therapy in order to implement some of these techniques country-wide. It’s going to be a busy three days of training but we are looking forward to it and can’t wait to update you on the events that happen in the following days.
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Where’s Malawi?

Malawi is in southeast Africa – just north of South Africa and south of Tanzania. About 14 million people live there in an area the size of Pennsylvania. Most Malawians are farmers, and many grow whatever they eat in their own garden. Lilongwe is the capital of Malawi and our final destination is the village of Namitete – 45 miles west of the city. It will be summer in Malawi – rainy and hot.

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Takeoff

Our bags are checked, we passed security with flying colors, neck pillows are in place, and we’re ready for takeoff!  Our journey begins from San Francisco to Lilongwe.  Our first stop is in New York tomorrow morning then its off to Johannesburg on a 14 hour flight.  We plan on doing ankle pumps and squats in the back of the plane to prevent any deep vein thrombosis!  From Johannesburg we have our last connection to Lilongwe, Malawi.  We’re so excited to begin this new adventure, get into the hospital to work, and immerse ourselves in the Malawian culture.  We’ll keep you posted and tell you about our travels beyond Pacific!

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