So in this picture is the oh so famous Peter and his little son Aim, the beautiful beautiful child Aim. A three year old in all ways, it is impossible to get annoyed with him because his smile is just so damn cute.

Although Aim has many talents, I think his particular talent is telling secrets. Whenever he has something he wants to tell you, he starts creeping up to your chair, and then instead of leaning over to whisper in your ear, he sticks out his ear as if it was you who were about to tell him something. Then, cheek to cheek, he begins to whisper his secret straight ahead, to no one in particular. 

I'm trying to convince Aim that he needs to be a model, so we spent a large part of the breakfast practicing holding butter and peanut butter cans. He has down the brand exposure and the "I love jiffy" but we just have to work on his ability to keep his food in his mouth.

Finally having figured out how to post pictures, here is a long overdue shot of the hospital I am working at, St. Andrews. Charming in many ways, one of it's particular draws is the way that chickens and patients share the same waiting space. The other day, Peter had left his office open while going to grab something from the pharmacy and he came back to see a chicken perched on his table. The chicken feathers began

 quivering, and afraid of an attack, Dakota and Pe

ter left to go get a security guard to deal with the feathery problem. They came back to a compounded problem: instead of just a chicken, there was now a chicken and an egg. After this, of course, it was Peter who vacated his office for the afternoon, leaving the chicken and the egg to preside over his charts.

In the continuing introduction to the hospital, here is the operating "Theater." We are slowly trying to de-britainize the hospital and introduce American terminology, but so far we have only managed to change chips to french fries. Here is where all of the procedures take place from the treatment of burns to cellulitis. What is pretty interesting is that the anesthetic used here is called katamine, also known as "Special K" in the US. Originally used as a horse tranquilizer, this drug allows the patient to mentally disassociate, which is really another way of saying that this anesthetic gives the patient a hell of a trip and some pretty intense hallucinations. Awake during the procedure, though the patient feels little to no direct pain, they are still able to react. Because of this, many patients still kick and scream during the whole procedure, giving the impression that they have broken through and are feeling every little cut. Very disconcerting to witness, it is pretty hard to believe that the patient truly feels nothing when they cry with such conviction, but no matter how intense the procedure is, when the patient awakes from the drug, they will remember nothing at all. 

Hard to believe at first, I was given proof of Katamine's amnesia affects when we had a burn case come in, a little girl who had fallen into a fire and sustained burns all over her right arm and leg. White people in Malawi are known as "Azungus," and out here in the village, they are still quite a novelty. Children especially are in awe at the sight of an Azungu, some having never seen adult white people before. Given the scarcity and the abnormality, you can imagine how terrifying three Azungus can be in the procedure room. Now imagine the intimidation factor when you add an incredibly potent hallucinogenic. During the procedure of this little girl, she was both yelling in pain and in fear of the white people around her. During the procedure, she alternated between asking for an "Obama," (a Malawian cake,) and yelling in fear about the "Azungus" that were in the room. I was pretty sure that the little girl would cower when she saw me again, but when I saw her yesterday, she was completely friendly and happy. Thankfully, her burns are healing quite nicely, and she has absolutely no memory of the operating theater at all.

On another note, a strange coincidence found its way into the hospital today, something that seemed straight out of a Malawian CSI show. Late yesterday, two men came in complaining of excruciating abdominal cramps. Both were watchmen at one of the local tobacco farms, and both traced the origin of their symptoms back to the lunch of encima that they had shared.  Arriving at the hospital, the first man had incessant diarrhea and vomiting while the second had no outward symptoms, only an intense stomach cramping. When we left for the night with both men were in relatively stable condition, though still in intense pain.

            Upon arriving at the clinic this morning, we were greeted by a slew of policemen. Apparently, one of the men, the man who was unable to either vomit or go to the bathroom, had died the night before. Fairly stable for most of the night, at about 1 am he began foaming at the mouth. Though they called the doctor on call, the man died only minutes later, before the doctor had time to make it to the hospital.

            It was only at this point, when the medical facts were on the table that the whole story finally came out. As it turns out, one of the men, the man who had survived, owed a boss on the tobacco plantation about 3,000 quatcha, ($18.) The boss had been attempting to collect his debts for the past few months, but the guard had been refusing to pay up. It was actually this same boss who had prepared the meal for his two guards that day. After news of the man's death circled back to the village, the boss was overheard lamenting what he had done, saying he should have never prepared the encima. Though not quite a complete confession, the guilty conscience can be a fairly reliable thing. In this case, if the boss is the one in fact responsible for the poisoning, then the tragedy remains that this boss, meaning to kill the indebted man, ended up killing an innocent man sharing the lunch. So the guilty man lives, the innocent man dies, and it was all for only $18.

To end on a happy note, here is a picture of the kids at St. Andrews-- quite acrobatic.

July 26-29, 2009

Never having blogged, we will have to see how this goes. Somethings just seem so hard to relate over the internet... 

Also, in fair warning, I get really wordy sometimes. Entries can get really long so stop at any point :)

I am currently staying at St. Andrews, a small village about 20 min outside of Kasungu, one of the larger towns to the north of the central region. I'm in the house of the clinical officer, Peter Minjale, who practices at and practically runs the St. Andrews hospital, a missionary hospital which has a "theater" (british speak for surgery room,) a labor and delivery ward, an antiretroviral clinic, an HIV testing and counseling facility, a lab and I guess what we could classify as a general emergency/treatment room. 

The people here are absolutely incredible; Malawians couldn't be kinder or more generous. I have been completely welcomed into the Minajale's home and into the community, with a 4 hour church service on Monday where I was more or less presented to the congregation. Needless to say, the church service was slightly exhausting, and I found myself nodding a bit until I was given a thoughtful awakening by a little girl that was sitting next to me. I had been playing with her all service, which was really entertaining until she decided to start sucking on her hand. She would then take out the fist covered with saliva and reach for my hand and my shirt. I tried to shift away, but was packed into the pews, so I had to accept my spitty companion. I though I was being a really great sport, and was quite proud of myself. Things were going pretty well until the little girl went onto the ground and began crawling around my feet. She decided my right foot was a good resting place and sat down on it. I was considering what to do when I all the sudden felt a wet warmth. Yes, she peed on my foot, and the worst was that I couldn't get up and move spots during the service so was forced to sit next to my peer and the puddle for the rest of the service.

Since this welcoming sunday, I have been working at the hospital. Suffices to say that it has been inspiring, depressing, challenging, and everywhere in between. The hospital workers- be them Clinical Officers, Nurses, Techs or Counselors- are some of the most amazing and hard working people I have ever seen. Always, faced with limited resources, the are supremely aware of the needs of their patients and offer care that surpasses that of many Western clinics with the world of medicine at their finger tips.

I spent most of the day today with the HIV counselor who performs the HIV testing and counseling. Though the number of those infected has been reduced from 14.6% to 12.5%, the size of the population living with HIV is astounding. Even more incredible is the fact that so few are tested and so few have access to treatment. Today, at our testing, there were 5 people who traveled at least 15km or 3 hours by foot to get to St. Andrews.

One really interesting thing about the HIV perception in the communities is that it is normally the women who are targeted as the spreaders of the virus. Though statistically, it is very difficult for a female to transmit as opposed to receive, women are the scapegoats chosen in their families. All of the tests we performed today were on women whose husbands wouldn't be tested. Apparently, men wait to be tested to see what results their wife will get; if the wife turns out HIV negative, they will consider getting the tests themselves, but if the test comes out positive, they will most likely never come and may very well divorce their wives because of their condition. Still, these women are incredibly stoic and they take the news, whether positive or negative, with incredible fortitude.

One particular younger woman was very nervous throughout the whole process. The counseling session was underpinned by the sound of her foot tapping on the floor. Extremely composed, the rhythmic tapping was the only sign of her nervousness. Happy to say, her test came out negative.

So as a last comment, and on a lighter note departing from the hospital, I went to the larger town Kusungu yesterday. So one of my favorite things about Malawi is what has penetrated the country through the T.V. Locally, their favorite productions are these music videos. Even better than the low budget ones I saw in India, these videos consist of 2 or 3 people dancing in open fields while music plays in the background. No words really to describe it, just watch this:

http://www.youtube.com/watch?v=nqcTtig7S-8

(also I would have to say this is even more high budget and choreographed than the ones I have seen, I'll keep looking for the real thing...)

            Almost as great as these local productions are the films imported into Malawi. You look at any DVD collection and they consist of action movies, war movies and war movies. While there are tons of Jean Van Dame and Stylvester Stalone, my favorites are DVDs that literally are just called WAR WEAPONS. These DVDs are covered with pictures of Osama Bin Laden and military equipment. When you turn the DVD over to see the episodes, they detail different  desert war tactics and devices. We worry about grand theft auto, these DVDs are literal war celebrations; it is amazing that Malawians are such happy, friendly people.

            Along the same lines, there are two international figures that have attained comparable statuses of import in Malawi: Obama and Bin Laden. As it turns out, the two are equally famous and celebrated by Malawians in truly unique fashion, with cakes. The Obama cake is a big white roll topped with granulated sugar. The Bin Laden cake is larger, harder to manage by one person, and is all covered with flour. Whiter than the Obama cake, the Bin Laden cake leaves a white residue around the mouth. One wonders... Normally, the two sweet leaders are sold side by side. Dakota and I were wondering what would happen if you took half a Bin Laden cake and attached it to half an Obama cake; we figure either the world would implode or there would be perpetual piece J