Where are the others?

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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

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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.

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

 

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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!

 

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

 

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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.

 

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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!

 

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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

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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.

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.

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

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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.

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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.

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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!

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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!

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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.

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

 

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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!

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…

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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!

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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.

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Four under the same roof.

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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.

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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?

 

img_2016Our 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!

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The market place in Lilongwe.

 

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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

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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.

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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!

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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.

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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!

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With warm hearts,

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

 

 

What Happens When Students Become Teachers?

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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.

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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!

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With Warm Hearts!

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

38 Hours Later

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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.

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

 

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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.

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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.

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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.

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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.

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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

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Zikomo!

2015-12-19 12.20.42This is Casey Nesbit, Assistant Professor and Director of Clinical Education at the University of the Pacific. It’s been a privilege to be with Abby, CJ and Sarah here in Malawi. I’d like to thank them for their commitment to the people and their contributions to the rehabilitation team. I’m still here working at the hospital and everyone is still asking for the students!

When we gathered to reflect when the students finished their last day here, our discussion lead us to thoughts about the importance of education. We asked ourselves about the sustainability of what we do here. We felt that the focus on educating our patients, their families and the community health volunteers that support them in the village was one of the best ways to make our impact sustainable. Given the sense of community here, I would like to think that the knowledge about physical therapy that we have tried to provide to the people here will spread. A caregiver for a patient with a stroke in a village, for example, will likely reach out to others in her community with similar difficulties to provide assistance and share knowledge.

Many thanks to you, Abby –  for your thoughtful creativity, CJ –  for your energetic patient interactions, and Sarah – for your courage as you faced uncertainties.

I hope you have arrived home safely and have a wonderful holiday.

Dr. Nesbit

“Tsalani Bwino, Malawi”

“Stay well, Malawi”

Fireside chat by Abby:

It is hard to say good-bye to Malawi. But I also know, that I will be back here someday. Malawi has moved me and molded me in a way that is irreversible and priceless. This experience has changed the way I see myself as a PT and as a person. I will always call upon these experiences and relationships with my patients and colleagues at St. Gabriel’s as I develop as a clinician. Throughout my time here, and despite the many challenges on both a physical and emotional level, I have never felt so supported, so appreciated, and so welcomed into an already close-knit community. I am so proud of what we have accomplished here, and how hard we worked to help our patients and share our knowledge with them and their caregivers. Zikomo kwambiri to Dr. Nesbit for providing a safe and nurturing environment for us to encounter difficult situations and rise to meet them on our own terms and in our own time. Thank you very much to all of the nurses, clinical officers, and staff at St. Gabriel’s for warmly welcoming us as physiotherapy students, and enthusiastically employing our skills to enhance patient care. And zikomo kwambiri to all of my patients, for putting your trust in me and for bringing me wholeheartedly into your story of recovery. Mwakhoza, mwakhoza, sure!!!

 

A personal note from CJ:

It has been awhile since I’ve written…this move was not intentional but mostly driven by exhaustion. Each night was a moment of personal reflection for myself and I often found it difficult to visit those thoughts again to write them down. Our short time in the hospital is difficult to articulate. We had moments of success followed by moments of difficulty. I found myself quite connected to a few patients here and on the last day of treatment I felt like I was in a haze. Like time had just warped past us and suddenly I found myself unable to treat and spend time with the patients I began so dearly to love. I found peace after talking with the group and recognizing that our efforts to rehabilitate our patients will not terminate once we leave. The culture in Malawi is so different from the United States. It’s a culture I’ve grown quite fond of even though our stay here was so short. Here – guardians, caregivers, brothers, mothers, fathers, and sisters stay at the hospital with their loved ones. The hospital even has huge infrastructure where the caregivers can cook and stay. Even though having a family member at the hospital often causes financial burdens that seems to be besides the point…

What is especially unique is each caregiver watched us intently. Each treatment session included the caregiver so that they may continue to care for their loved one when the therapist is no longer present or when they go home. It was such a rich interaction between people. It was personally and emotionally alive. A team. A family. A group that shared a common goal. To bring someone back to function. Back home to their village. After our last treatment session Dr. Nesbit gathered us all around and I found it difficult to summarize our stay. To put a final point on all that we had gone through. Ultimately the experience allowed me to simply feel human. To understand something beyond myself…beyond my everyday naggings and to understand something greater. To fall in love with a culture, and a system despite being so very different from the system at home. Even though we leave tomorrow morning I already feel the draw to come back. So – it will happen. A returning journey.

 

A side note from Sarah:

As I pack up my last “chitinje” in my overstuffed suitcase, it’s unbelievable to think that this experience is coming to an end. I can recall when my second year buddy first shared with me over a year ago how she was going to Africa to provide physical therapy education and treatment. Due to my passion for public health interventions in the physical therapy setting, I quickly jumped into the application process. After finding out that Abby, CJ and I were going on the trip, I heard many stories, read books, and attended weekly classes all in preparation for this exciting experience. I was not prepared for interactions I would have with this country and it’s people that brought me to a place of humility and vulnerability. At times, I was filled with optimism for these patients as they had a favorable prognosis. In other moments, I was heart-broken at the social injustices present, as I knew that if these patients just had different resources or circumstances, their rehabilitation would be quite different. However, after my interactions with the clinical officers, nurses, and doctors at the hospital, my hope for these patients was restored. St. Gabriel’s Hospital is filled with individuals who are working with the patients and their caregivers to achieve the best outcome. To say it was difficult walking down the hospital corridor one last time would completely minimize how the three of us were feeling. We have been given a honestly life-changing experience from these honest, genuine, and kind people. I look forward to my return to this country knowing that I will be warmly welcomed again.

 

 

 

Nkhani

“Stories”

This last week has flown by…we have been so busy with our patients and each day we are stopped several times in the hallways by one of the physicians telling us about a new patient that would benefit from physical therapy or “fizio”. We have finally found our rhythm here at St. Gabriel’s and now it is time to go home…and leave Dr. Nesbit all by herself with all of our patients! We have all grown as therapists and as people from this experience, and our patients have imprinted on us on both an intellectual and an emotional level. We want to share some of their stories:

Mr. N

This was our very first patient, who we treated for weakness on one side and neglect due to a stroke several weeks prior. He had been in the hospital for two weeks before he was referred to us. When we first started working with him, he had a very flat affect, had difficulty following one step commands, and he could not sit at the edge of the bed without assistance. Within a week and a half, he was walking with a cane as well as support from his caregiver, smiling and sitting up on his own when we walked into his room, teasing and joking with CJ constantly, and able to perform transfers independently. He has been a joy and an inspiration to work with and to witness such accelerated progress not only in terms of functional mobility, but with regards to spirit and personality as well. He wants to return to his village as soon as possible and we are confident he will get there soon.

 

Elisabeth

One of the best parts of being a PT is getting to hear about our patient’s lives through stories. It allows us to be reminded of the human aspect of patient care. We have heard amazingly wonderful and hope-filled accounts of their lives but also face emotionally devastating stories from our patients. Elisabeth was one of those patients who we only got to see for one hour one afternoon. She was with her father who had brought her to the hospital after actively laboring for several days at home in her village. The difficult birthing process resulted in the death of her child and numerous health outcomes, which without medical attention, would result in negative social implications for the 16 year old. As difficult as it was to hear about our patient and her heart-breaking story, the soft-spoken teen was willing to exercise in order to improve her pelvic alignment as well as her gait economy. All of us were deeply touched by her sweet disposition and the caring heart of her father. Elisabeth taught us how a patient is more than their medical/physical therapy diagnosis. There is always a story to be heard.

 

The Little Artist

We met this patient in the hallway of the FCCU…he was a chubby, adorable toddler tucked securely onto his grandmother’s back with her colorful chitinje. We found an empty room and settled onto the floor, and then she showed us his hands. He had some of the worst contractures any of us had ever seen. He was burned in a fire when he was 3 months old and his hands had healed into fists. One hand had recently been surgically released and the other hand was scheduled for a similar procedure in a few months. Our role was to prevent the surgically treated hand from reforming a contracture. We used what we had available to us to create a splint: a toilet paper roll, a small plastic bag, and a pair of latex gloves. He was a very quiet and cooperative patient and seemed to really like his new splint. His grandmother told us that he really wanted to go to school although it was hard for him to hold a pencil. In order to go to school in Malawi you must be able to hold a pencil. So we tied a cloth around a pen to make it easier for him to grasp and tied the cloth around his hand to help his finger flexors do their job. We gave him a pad of paper and he drew us a beautiful, scribbly truck. We told his grandmother that this little artist should definitely go to school, even if she needs to wrap his pencils in cloth each day. This little guy was incredibly inspiring.

 

Mr. V

This patient was referred to us for physiotherapy by a clinical officer from the male ward. Mr. V had a stroke with associated co-morbidities. When we first met him, he was unable to look to one side and couldn’t vocalize at all. We’ve visited Mr. V twice a day for the past week and have seen steady improvements including his ability to stand up, remain standing, and even take a few steps with assistance. He also was able to move his mouth as to respond to a common greeting exchanged in Malawi! We’ve also enjoyed seeing this patient’s personality surface as his rehabilitation progresses. For example, while working with Mr. V, Sarah accidently referred to him with the wrong patient name. Mr. V stopped what he was doing, looked at her, and gave a crooked little smirk acknowledging the fact that she had goofed his name! He has an incredibly supportive family that is working hard alongside of Mr. V. We are very hopeful and anticipate this patient has a good prognosis.

 

Grace

Grace, as her mother, as well as all of us call her affectionately, is a beautiful little girl with big, brown eyes and a stunning smile. She loves to be sung to, she likes to eat phala (maize porridge), and she likes to play with your keys and makeshift balloons made from latex gloves. She is also severely disabled due cerebral malaria which has resulted in her being highly irritable, and suffering from involuntary, writhing movements on one side and head, and spasticity on her other side. Her case is the most tragic one we have seen, and her prognosis for returning to the normal activities of a toddler is extremely poor. By working as a team and with the guidance and expertise of Dr. Nesbit with pediatric patients, we have witnessed some small triumphs with this patient including sustained eye contact, smiling, and giving her the opportunity to engage in play. In order to work on head control, we devised a makeshift supportive seat using a plastic chair, several rolled blankets, and a chitinje. In this position, Grace has been able to explore playing with her right arm as well as quiet the rest of her body for a few moments. If this child were in the US, she and her mother would be provided with extensive resources in the form of adaptive equipment, social security, medical management, and emotional and family support. These resources are not available to them in Malawi, and it has been very difficult as outsiders to accept this stark social injustice.

 

The Hip Ladies

We had a lot of fun and a lot of laughs with these two patients. They were both elderly women with high femur fractures who had been on traction of the last 4 weeks in the female surgical ward. We took a team approach to their treatment and concurrently taught them exercises they could do in bed to strengthen their legs for walking. Then, since we only had one walker, we took turns getting them up out of bed and walking around the ward. Although they were both weak and stiff from being in bed for 4 weeks, they were determined to get moving. Pretty soon, they had the entire ward cheering and laughing as they each took their turns using the walker and announcing that they were headed to their village. At one point, we asked one of the ladies if she was tired and she straightened up and said determinedly: “Tiyeni!” (Let’s go!). We were all thrilled for this opportunity to work with such lively and motivated patients, as well as provide entertainment for the entire ward.

 

Agogo in the Village

By far, the Agogo (which means grandmother in Chichewa) in the village was one of the sweetest and spunkiest patients we have seen. She is very elderly and had a stroke a few years ago resulting in increased tone of her arm and leg on one side. This patient was one of the few patients we visited in the village and every time we visited, all of her family and grandchildren were present for the appointment. In Malawi, before you enter a home you ask “odi?” meaning “can we come in?” The family would always warmly welcome us into their backyard that was already prepared with bamboo mats for us to do our treatment sessions. We worked on functional activities with this patient, which included placing a glass coke bottle or a cup in her left hand to relax her finger flexors as well as allow her to participate in household tasks such as processing maze. This patient taught us that even if you don’t have state-of-the-art equipment, you are still able to be creative and assist your patient! We were also grateful for the ability to be welcomed into their home and for Agogo’s willingness to perform exercises with us.

 

The Mango Tree Boys

While at St. Gabriel’s, we’ve had the opportunity to visit quite a few pediatric patients. In the pediatric ward, there are areas designated for various pathologies including malaria, malnutrition, respiratory infections, etc. However, as you approach the end of the ward, you reach the less severe patients who have fractured a bone, typically from falling out of a mango tree. You wouldn’t think this was overly common, but here in Malawi during mango season these kiddos are everywhere! Some of our most fun patients have self-formed a group that we like to call “The Mango Tree Boys”. They are compliant with their exercises and have become very mobile! Even on our walk this morning, we saw the group outside of the hospital ambulating using their colorful pediatric loft strand crutches and having a blast. These boys have become Abby’s shadow due to her giving them candy! They bring a lot of hope to the pediatric ward and have been a joy to watch as they progress to recovery.