Where are the others?

I’ve been asked this question by so many people over the past few days…the gatekeeper at the hospital, the hospital secretary, the hospital administrator, the coordinator for Home Based Care, the nurses and the patients. Alycia, Melody and Samantha, you are missed by the people here and by me!

I’m grateful for your sensitive, caring way. You embraced every experience and stepped out of your comfort zone to put others first. The people you met and the patients you cared for have touched your lives – just as you have touched theirs. I’ve been here for many years, and found this years’ patient cases to be some of the most challenging. We relied on each other for consultation, support and encouragement. As a team, we did our best.

By the end of your short time here, you were moving about the hospital, gathering “hallway” referrals, and responding to your patients. Each of you tackled physical therapy evaluations in Chichewa, reasoned through unconfirmed medical diagnoses, and made the best decisions with the information available. These are remarkable accomplishments.

I was very proud when the Matron spoke to you in front of the group of community health volunteers – telling you that you have showed respect for the Malawian people and joined in their culture. You have represented yourselves, the University of the Pacific and our profession well.

The gift of education about physical therapy that you have given to the community health volunteers, to the medical staff, to the Malawian physical therapist student who joined us for your last days, to your patients and to their caregivers will live on.

You are ready, now, to take on any global challenge.

All the best for 2017!

Zikomo kwambiri,

Dr. Nesbit

Tsalani Bwino!

And Merry Christmas! As we pack our suitcases and reflect on our time here in Malawi, here are some fun memories we wanted to share.

In the FCCU with two staff members who were excellent translators for us.

 

Ruthie is a physiotherapy student here in Malawi. She spent a couple days seeing patients in the hospital with us. It was wonderful to get to know her and we are confident the future of physiotherapy in Malawi is in good hands!

 

This picture was taken right before we said goodbye to Ruthie. It was surprisingly emotional saying bye to our new friend and colleague.

 

We had the pleasure of celebrating Alycia’s birthday here in Malawi! The man pictured here is John, a wonderful chef who was determined to bake a birthday cake for Alycia. This cake took days of planning on his part to find a solid hour of electricity to power the oven.

 

A close up of John’s masterpiece. Knowing how much work went into this cake and how proud he was of the finished product made the cake taste all the more delicious!

 

Our last time walking out of St. Gabriel’s Hospital. We are so thankful for the opportunity to come here and for all the experience we’ve had. Our lives are forever changed by the people we have met, people who truly warm your heart. It is no doubt that Malawi is known as the “Warm Heart of Africa”.

We hope you all are enjoying time with your loved ones on this Christmas day. We look forward to seeing you soon!

With warm hearts,

Samantha, Alycia, and Melody (S.A.M)

 

 

 

 

 

 

 

Patient Stories – Part 2

Mr. F and Mr. M

We didn’t expect to hold these two patients so close to our hearts upon first meeting them. After a full week of working with them daily, Mr. F and Mr. M are two patients we will never forget.

We first met Mr. F in the FCCU, Family Centered Care Unit, which is the hospital’s palliative care wing for patients with chronic conditions. Mr. F had an HIV related stroke and when we first saw him he was emaciated, weak, and couldn’t hold any food down. Simply getting him up and walking with a front wheeled walker was a demanding task for his fragile body.

We first met Mr. M in the male ward, which is a general ward where patients requiring around the clock care are admitted. He too had a stroke but was not speaking or communicating through gestures. During our initial evaluation, we couldn’t even get him sitting up because he was so unresponsive. However, since his condition was stable, we recommended that he be transferred to the FCCU where we could work with him more closely.

When Mr. M transferred to the FCCU, he was brought into the same room as Mr. F, which we initially thought was strange since there were so many other open beds that would provide more privacy. Each patient, in order to be admitted to the hospital, must have a caretaker with them for the entire duration of their stay. The caretaker, typically a family member or close friend, gets the patient to the bathroom, cooks their meals, and provides for all their basic needs. We quickly learned that patients prefer to share a room because the patients and their caretakers become a support system for each other. Frequently we would walk into the room and Mr. F’s caretaker would be over with Mr. M’s caretaker helping to sit him up so he could eat. Although they never met before their hospital stay, they became each other’s supportive community. It was incredible to see how they helped each other out!

Throughout the week, we would come and work with Mr. F and Mr. M early in the morning. As Mr. F made progress walking, getting stronger, and gaining more control over his affected limbs, all the caretakers in the room would cheer together as they were now part of each other’s roads to recovery. Mr. M also made progress as each day he was more alert and responsive though he never did communicate with us verbally. Mr. M also had a strong case of Pusher’s Syndrome which provided quite a challenge for us as we attempted to support his tall frame towering over our own. Mr. M’s wife, who was quite a boisterous and animated woman, frequently helped us mobilize Mr. M and would repeat our instructions with extra emphasis, making us laugh. Getting to know her gave us some insight as to what Mr. M’s personality must have been like before his stroke.

Both patients made improvements every day but we did not fully realize the progress they made until Thursday afternoon, when we returned to see them for the second time that day. To our surprise both Mr. F and Mr. M were outside with their caretakers enjoying the fresh air and having their afternoon tea. They were all smiles as we walked out to greet them with our jaws dropped. Mr. F was long-sitting on the ground all by himself, looking happy and energetic. Mr. M was seated in a wheelchair with erect posture and able to make and maintain eye contact! We decided to forego our afternoon session of physio and let them enjoy their time outside. They had taken the skills we taught them and ran with them, and we couldn’t have been happier.

Alycia and our Malawian physio student friend working in the male surgical ward.

Doing a home visit for a patient with a stroke in the village nearby.

Doing a home visit for a patient with a stroke in the village nearby (view 2).

Doing a chart review before going in to see a paient.

With warm hearts,
Samantha, Alycia and Melody (S.A.M.)

Patient Stories – Part 1

It’s hard to believe that we have completed one full week of seeing patients in St. Gabriel’s hospital. It is even harder to believe that we only have a couple more days left here in Malawi! As we wind down after completing our last full day in the hospital, we wanted to take some time to reflect on a couple of the patients we saw this week that have made a huge impact on us.

*Patient names have been changed to protect their privacy.

Little Joe and Little Mickey

These two young patients were waiting for us the very first day we were in Malawi! We were just getting a tour of the hospital for the first time when we were informed that we had two patients already waiting for us.

The first one was Little Joe, who was referred to us with a diagnosis of stroke. He was your average active adolescent boy until a couple months ago when he started to loose function in his left upper and lower extremity. A young boy with a stroke just didn’t make sense to us. In addition, he was complaining of headaches, nausea, and vomiting which stood out as huge red flags. After a thorough evaluation, we had a strong fear that something more was happening in this boy’s brain than was currently being explained and it would only get worse. We urged his caretaker to take him to get a CT scan, and thankfully he managed to get the funds together quickly to take him shortly thereafter.

The hospital’s head doctor was informed of Little Joe’s case and took a special interest in following him. Once he received the results of Little Joe’s CT scan he personally walked the file over to our house even though it was late and after dark! Unfortunately, the CT scan showed a brain tumor.

Only a couple days later during our morning meeting with the hospital staff, we were informed that Little Joe passed away. We couldn’t believe it. We had just seen him. He was way too young. We only spent a few short minutes with him, but we hope that the concern and care we provided, and how we fought with urgency for him to receive further medical attention made him feel loved in his last few days.

After that initial evaluation of Little Joe, we saw and evaluated Little Mickey. Little Mickey is a toddler who was terrified of us “azungus”. As soon as we stepped into the room he burst into tears and loud sobs. His presentation was very similar to Little John’s and he had received the same diagnosis of stroke. Little Mickey and his mother stayed at the hospital for a couple days and we came to work with him daily. However, when we started to suggest that he should be taken to get a CT scan, his mother decided that she needed to take him home to see the local Traditional Healer because it was her husband’s wish. We were heartbroken at this decision, but there was little we could do.

When the hospital’s head doctor was informed that Little Mickey and his mom had gone home, we were so happy to see that the decision bother him as much as it bothered us! He told us that we needed to go visit the boy in his village to convince the father that Little Mickey needed to have a CT scan. So we were off, escorted by Alex, our good friend and the hospital’s coordinator of Palliative Care, to go visit Little’s Mickey’s village. After an hour long car ride through unpaved, rocky village roads we arrived.

Our sturdy little vehicle taking us to Little Mickey’s village.

Little Mickey’s village with all of the village kids on the right watching us (Alex is taking the picture!).

Little Mickey sure wasn’t happy to see us as he immediately burst into tears once again, but taking the time to come to their village definitely had an impact on his parents. While we did some exercises with Little Mickey in the hut, Alex was outside trying to convince his father and his grandparents of the need for a CT scan. After a family meeting, they all joined us in the hut to present their final decision. We were overjoyed to hear that they decided to take the little boy for the CT scan! Alex explained that until we showed up in their village, they had already made plans to take Little Mickey to the Traditional Healer that afternoon, but since we went out of our way to come see them, they agreed to follow our medical advice.

The three of us sitting in Little Mickey’s hut.

What an emotional roller coaster this experience has been! What started with pain and confusion ended with joy and hope. We are still mourning the loss of Little John, but are glad that his story has made the hospital staff more aware of the severity of this presentation in little kids. We hope for a bright future for Little Mickey!

With warm hearts,

Samantha, Alycia and Melody (S.A.M.)

What’s On the Menu?

It always depends. Meals here, similar to the trend of our schedule, are continuously dependent on factors outside of our control. Meals are based on the availability of electricity, whether there’s bread or certain vegetables available in the market, the amount of time we have available to cook and/or if we can get the coal burning stove to warm up enough.

Without power, this has become our nightly setup eating dinner by candle light!

One method of cooking we tried to adapt early in our stay was to learn to cook on a small coal burning stove. Most Malawians cook this way and we were eager to try so we did not have to depend on the unreliable electricity. Our first instructor was the hospital cook. He showed us how to light the fire and let the coals burn slowly enough so they could last for hours. After he showed us once, we were sure we could do it by ourselves. Our next solo attempt was hysterical. We took nine matches to get the kindling to stay lit and spent at least twenty minutes fanning the flames until the coals were lit enough. Even though it was time consuming and more difficult than we anticipated it has been fun to learn!

Our very first coal fire to cook our dinner!

Regardless of our methods for cooking, we’ve been incredibly fortunate and have had great luck with each meal. Each time we were in Lilongwe, we went to a Western grocery store and went grocery shopping. We got basic food items we were familiar with such as spaghetti, noodles for mac and cheese, bread for grilled cheese and tuna melts and vegetables for curries. While at our base at the hospital, we have traveled to Namitondo nearly every other day for extra supplies. There’s a little farmers market that sells tomatoes, green vegetables that slightly resemble kale, onions, sardines and a few other items. There are also men that cook in a giant pot that sell ready to eat items. One of these items is called chips, essentially French fries. We love them!

One of our favorite meals of grilled cheese and chips and roasted corn from the village with Peri Peri hot sauce! Don’t worry, not all of our meals were this beige.

One of the first days we were here, we visited the man picked us up from the airport, Nicholas. He is a baker in Namitondo. He took us behind his home where a giant brick oven was located. He showed us through the process he went through to make bread. It was so fun! We were eager to try his bread but none was baked yet so we promised to come back later. Throughout the past week and a half we have picked up bread from Nicholas regularly for lunches and dinners. Or so we thought. Dr. Nesbit came with us only on the first visit to Nicholas’s bakery. It wasn’t until this week she came with us again and kindly pointed out that we had been getting the wrong bread the entire time. All three of us forgot which shop was Nicholas’ and we had accidently been buying from the shop next to his! Needless to say, the shop owner next to him likes us very much.

The dough shaped by hand and ready to go in the oven!

 

Nicholas’ brick oven. It must take a lot of skill to get his bread to cook so evenly in there!

 

Although the meals we have made ourselves have been great, they have been very American and we were eager to try more “authentic” food while we were here. The hospital has a cafeteria so last Friday night we went there for dinner. We tried nsima, a corn based porridge that is thick enough to mold with your fingers. To eat nsima, you break off a piece and roll it around in your fingers to soften it up. Then you wrap it around a few veggies or dip it in a sauce. It was very filling and tasted delicious!

Nsima!

Our first true Malawian meal of chicken stew, vegetables, and chips.

Regardless of how we have obtained or made our food, we sure have had a fun time throughout the process.

With warm hearts,

Samantha, Alycia and Melody (S.A.M.)

It Depends…

Only one day into treating patients in the hospital and the two phrases we have said more than anything else are “make a plan” and “hurry up and wait.” As much as we try to plan our day, our schedule seems to be ruled by the availability of electricity, rain, visitors, and last minute “hallway” referrals.

Generally, on treatment days, we can count on having our morning meeting with the hospital doctors and nursing staff at 7:30am every morning, our lunch break somewhere between 12-2, and ending our day at the hospital around 5pm. Everything in between is tackling whatever the day throws at us!

On Sunday (our yesterday), we planned on going to the village church service, which we were informed started at 8am. We got there promptly on time but 8am slowly rolled by with very few people filling the pews. By 8:45am someone announced that the Father was on his way. Finally, Mass started at 9:30 and lasted until 11. When it was over, we were glad to finally stand up and stretch our legs!

We had planned to go to the village of Kamangira after lunch, but as we were preparing to leave, dark storm clouds rolled in, followed by thunder and lightning delaying our trek to the village. After about half an hour, the rain died down to a light sprinkle so we bundled up in our rain jackets and started the hour long walk along a muddy dirt road to the village. Thankfully the rain stopped halfway and the weather remained temperate for the remainder of our walk!

Our walk to Kamangira.

Kamangira is a village Dr. Nesbit visits every year, takes photos of the people there, and brings them photo albums of the pictures from the previous year. The children were the first to greet us as we approached the village and before we knew it we had a whole pack of kids excitedly following us around. They loved taking selfies with us, especially Alycia, who got them making funny faces at the camera. We were also happy to finally meet some little babies who smiled at us rather than burst into tears!

We had the opportunity to meet the most adorable auntie, whom Dr. Nesbit had met for the first time 11 years ago, and has visited every year since. This 81-year-old auntie was so overjoyed to see Dr. Nesbit again, and graciously invited us into her home to visit with us. Auntie’s daughter, granddaughter, and great grandson ended up joining us in her home and it was incredible to see 4 generations under the same roof! When we left her home, she wanted to thank us and send us off with a gift of a live chicken! We politely declined, quietly chuckling at thoughts of us walking home trying to wrangle a chicken.

Four under the same roof.

Us with auntie!

Taking portraits for the rest of the village was a time-consuming task. As word spread that we were there, more and more people gathered around us. We even needed to get creative with our lighting by using the flashlights on our phones to brighten a dim room.

Mel and Alycia working as lighting assistants.

After a couple of hours, we started to see more dark storm clouds moving in on the horizon. We took that as our cue to say goodbye and start our walk back home. We made it home nice and dry, our hearts warmed by the wonderful people of Kamangira.

With warm hearts,

Samantha, Alycia, and Melody (S.A.M.)

What’s On the Schedule?

 

Our schedule today was one that continually evolved. It was our adventuring day. Our morning started out seeing a little baby in the hospital who was quite fearful of us as “azungus”.

Afterwards, we left the hospital for a day in the city of Lilongwe. Our trek began on the back of a bike. Bike taxis are regular bicycles with long cushioned seats on the back. They wait outside of the hospital gate eager to find customers. They quickly approached us as we walked over to them. We were a little nervous at first to jump on the back of a bike, putting our safety in the hands of a complete stranger, but we ended up loving the experience! The bike taxis took us down a long, paved road to the mini bus station where once again we packed ourselves into an overly full van which we rode the rest of the way.

The moment we stepped of the mini bus in Lilongwe, it began to downpour a typical Malawian rainstorm. We took cover under a building overhang, where we were soon swarmed by local artists eager to sell their crafts. We might even say a little too eager as we found ourselves pulled in numerous directions by artists wanting to take us to their booths to show us their work. After putting our bargaining skills to the test, we walked away with some wonderful souvenirs to take home!

We then wandered through the bustling market place. Our first stop was the produce section, which was packed with colorful, fresh produce. We picked out some vegetables for this week’s meal plan. Next, we crossed the most precarious looking bridge over a small river to another area of the market that sold fabric. We were happy to find fabric to take back to our village for the local tailor to turn into more souvenirs!

The market place in Lilongwe.

 

We made it across this bridge!

 

After stopping for a meal of comfort food, pizza and ice cream, we started our journey back home. This return trip turned out to be much more eventful than the first. The mini bus driver decided to take some back roads to avoid a traffic officer. These roads were made of dirt, rocks and giant potholes making the drive incredibly bumpy. We’re lucky none of us lost our lunch! When we finally got back on the main road, we were forced to pull over because the President of Malawi was driving through. What incredible timing!

After a long, fun, and exhausting day of travel, we are happy to finally be back home, and are looking forward to start this final week in Malawi!

With warm hearts,

Samantha, Alycia, and Melody (S.A.M)

We’re Still Students at Heart

The past three days of teaching the local Community Health Volunteers has been quite an experience! It felt so strange conducting our first round of skill check offs, but so rewarding to see such tangible progress with our students.

Two volunteers demonstrate a hand relaxation technique for a patient with stroke.

 

Their final practical exam consisted of putting their newly learned knowledge to the task by working with patients in nearby villages. They demonstrated such confidence and ownership of their skills! The picture below is with our first group of Community Health Volunteers upon graduation from our training course.

Though our main focus has been teaching, we have been learning so much more than we ever expected! When visiting patients in the nearby villages, we wore traditional Malawian wrap skirts, called chitenje. The women here make tying these skirts look so easy, but when we tried to do it ourselves it was very hard to get them to stay on!

When in the village, Sam was ready to assist her group of Community Health Volunteers as they did exercises with their patient, but unexpectedly found herself taking part in some daily chores. She learned that the Community Health Volunteers not only travel long distances to see their patients, but also provide assistance to the patient by performing daily chores such as gathering water from the well, cooking meals, sweeping the home, bathing the patient, and all without being paid! These volunteers maintain a regular job and still desire to devote their free time to making home visits to take care of these patients. They are heroes in our eyes!

Sam wearing a chitenje, drawing water from a well in the village of Msundwe.

 

Our transportation to and from the villages was by van. But this was no ordinary van, and no ordinary driving experience. There were 18 of us that needed to get to the village and only one van to take us there. We were shocked to learn that it is very possible to fit 18 people into one van! There were people sitting on laps, kneeling on the floor, even sitting on the driver’s seat headrest. It was quite a site to see for us, but a normal occurrence for Malawians.

Alycia and Melody (if you can find her!) stuffed in the van with 16 other people.

 

Finally, the thing we have most enjoyed learning is the Malawian song and dance! They start each training session by breaking into song and dance, all in perfect harmony and rhythm. They even brought us out into the center of the circle to learn their dance steps! Even though we were awkward and off beat, the energy and joy in the room made the experience one of the most enjoyable yet. We look forward to learning even more!

With warm hearts,

Samantha, Alycia, and Melody (S.A.M.)

 

 

What Happens When Students Become Teachers?

We came to Malawi knowing we would be teaching 60 community health workers, but what we were not prepared for were all the other spontaneous teaching moments we would have. As we were gathering equipment for our community health worker training, we were informed of two patients that came to the hospital specifically looking for us. Even though we were not expecting to treat patients for another week, we took Dr. Nesbit’s lead and jumped on the opportunity to treat these patients. Both patients were children with very complicated cases. This challenged us to think outside of the box to find the one thing that we could do to help them the most. Dr. Nesbit asked us to come up with home exercises that best fit the patients’ needs. This was our first experience teaching someone who spoke a different language. It was quite a task and it must have been very entertaining to watch from the outside!

Today we got our first taste of what it was like to teach our first full size class. We had a variety of personalities ranging from the student who always jumped up to raise his hand while the student next to him observed quietly. Overall it was satisfying to see them learn new skills and desire to take their learning to the next level. They were always thinking of ways to help their patients.

Just when we thought we were done for the day, we were asked to visit a neighbor down the street with complaints of shoulder pain. Upon evaluation of the adorable 84-year-old amayi (grandmother), we confirmed a clear diagnosis of shoulder impingement syndrome (Thanks Dr. Phelan!). Once again, we put on our teaching hats and taught her ways to sleep more comfortably and alleviate here pain.

When we finally came home, we were able to relax and watch the sunset with our new friend Bobby!

With Warm Hearts!

Samantha, Alycia, and Melody (S.A.M.)

38 Hours Later

We finally arrived at our home for the next 2.5 weeks at 5pm on Saturday. After taking some time to unpack and set up mosquito nets over our beds we were ready to finally lay down and get some sleep! But not until we cooked our first dinner of vegetable soup and grilled cheese sandwiches. With our tummies full, we settled in for a wonderful and much needed night’s sleep.

Our mosquito net setup! (It’s harder to set up than it looks)

 

The front of our house

Our first full day in Malawi started by waking up to the sound of a rooster crowing outside our window! We were thankful to have the morning to relax and soak up our beautiful new surroundings before heading out to get a tour of the hospital and explore the village.

Getting a tour of the pediatric ward of the hospital.

 

About a half a mile away from the hospital complex is a small village called Namitondo. Namitondo is a very typical village in Malawi. It’s built with a skyline of single story brick buildings and straw roofed homes.

The road to Namitondo.

 

We walked in through the entrance of the town and were immediately greeted by the shouts of kids yelling “azungu!” aka “white person”. We walked through one of the main streets with everyone’s eyes glued at us and ours on them. We visited the baker, who happened to also be our driver from Lilongwe, and he showed us how he goes through the process of baking bread. We walked through a small flea market with straw thatched stalls and a few vegetables and sardine looking like fish on tables.

Walking through the vegetable stalls

 

Dr. Nesbit negotiated with one of the women at the stalls for a few tomatoes and this green leafy vegetable that mildly resembled kale. On the way back from the little flea market, Sam and Alycia bought a couple sweet breads from the kids: Malawian donuts! Not quite like American donuts, but you can’t go wrong with fried dough.

Another abundant food item that has been easily plentiful are mangos. Our driver from Lilongwe was able to negotiate with a local seller and we got a dozen right away. (Soon hopefully we will learn to negotiate for ourselves!) They have been juicy and amazing! Sam was able to try one for the first time and they sure didn’t disappoint.

With warm hearts,

Samantha, Alycia, Melody (S.A.M.)

Are We There Yet?

After a long week of finals and saying goodbye to our loved ones and friends, we have made it to the first leg of this trip, San Francisco Airport! We have many hours of travel ahead of us, we will stop at JFK airport in New York early in the morning and then off to Johannesburg. Finally we will land in Lilongwe, Malawi where we will stock up on groceries, jump in our car and head to our final destination St. Gabriel’s Hospital. We are all so thankful and excited to be on this journey together, stay tuned for more posts about our experiences and adventures!

With warm hearts,

Alycia, Melody, and Samantha