Home sick with what I hope is just the flu. Slept for about 14hrs, so decided to catch up on some blogging...

Day 23: Malawian Women

Today, I started in the Medical Bay ward, which is where they send kids from the Pediatric Special Care ward that need more chronic care. Saw Memory there (the girl recovering from meningitis) and she was up walking on her own. No hearing loss or any other residual neurological effects. She looked great! Saw the usual plethora of medical problems, but wanted to reflect on the women of Malawi.

The way the hospital is set up, there are usually only 1-3 Sisters (nurses) per ward even if there are a lot of patients. The Sisters are responsible for distributing medications and giving shots. They will also start IVs, but a lot of the time Registrars or 5th year medical students usually start them (students go straight from high school to medical school, which is 5 years here).

The families (usually mom, grandma or other female guardian) do the majority of patient care. They are the ones who clean the patients, feed the patients, take the patients to the toilet and alert us or the sisters to problems. We see the occasional dad when mom has a little one or a lot of kids to tend to at home, but for the most part, the ward is filled with women.

The women carry children on their backs ranging from the newborn to the older sick child. They take a big, thick piece of cloth, put the child in a piggyback position and wrap the cloth around the back of the child, tying one end to the front end of her chest and another at her hips. It's fascinating (and more practical than strollers) because it leaves her hands free. In fact the only stroller I have seen was a nanny pushing a Caucasian kid down the street. Also, to keep her hands free she will carry anything on her head. I've seen the usual food baskets to suitcases to anything that will fit up there.

If the child is still breastfeeding, sometimes the mom will put the child in a sling on her side, so that she can whip the kid around and let him/her feed. Compared to the States, breastfeeding is natural here. The women have no embarrassment about pulling a breast out of their shirts and feeding their babies. Which seems to me the way it should be, but I know that when I have kids, if I were ever to try it, I would be socially shunned if I didn't "modestly cover up."

The women bond in the hospital, as a lot of time they don't have as much family support at there. It is expensive for people from surrounding villages to take a minibus to the hospital, and I'm always impressed by how long a mom will journey with a sick child to get to one. Ladies share their meals, watch each other's children when mom has to go to the toilet or buy food. They eat together, talk together, celebrate and mourn together. They are strong.

In public, couples (including husbands and wives) do not show physical affection for each other. In some villages they even have separate huts where the wife will sneak into the man's hut at night and be back in her own by morning. Yet, friends show public affection. You hold hands with same sex friends and give them hugs. It threw one of the guys here for a loop when he made a friend with a Malawian guy who later grabbed his hand while they were walking together. Fortunately, he was able to overcome the American social stigma and didn't pull away and offend his new friend.

Cultures are fascinating and just thought I'd share a bit about the Malawian culture, even if this ended up being a little longer than anticipated.



Day 24: Medical Bay

On the ward, we saw a lot of neurological cases. One 7 year old was diagnoses with encephalitis with ? cause. Her brain is atrophied. She is not talking or walking. We were trying to set up outpatient care by getting her a CP chair (cerebral palsy chair which here is a wheelchair base with a white plastic patio chair for the seat). Also were trying to get mom taught on how to move her limbs. We gave her Baclofen to help loosen her muscles, but there was not much else we could do.

Another 1 year old came in because she stopped walking. She didn't bear weight on her left leg and her foot dropped. Come to find out, she previously had meningitis and whoever gave her her Ceftriaxone (antibiotic) shot must have nicked her sciatic nerve one day.

Memory was discharged. Other patients had everything from anemia (? etiology) to nephrotic syndrome (the kids are swollen and they pee protein), to advanced HIV, L knee effusion, etc.

One boy had an extremely large abdomen that was distended with fluid, likely due to liver failure. He had so much fluid that he had a reducible hernia in his scrotum. The registrar showed us how to do a therapeutic peritoneal tap (needle in belly to drain fluid) and asked if anyone could remove it after 1.5 liters had been drained. None of the med students volunteered, so I stayed behind. Pulled the tube out and placed a cotton ball with tape over it. About 5 minutes later the kid started crying and grabbing his abdomen. My first thought was, "Oh, shit! Could I have done something wrong???" My next thought was "You just removed a tube. It's not like it's a difficult procedure." I talked to the Sister on duty and she gave him Paracetamol (Tylenol). I checked on him later and he was back to his usual self.

When I got home, I found out that all the interns are on strike. Apparently they haven't been paid since they started. Pediatrics wasn't hit as bad, but OB/GYN was. So two of the students went in that night on call to help out. From what I heard, they helped with vaginal deliveries, but no one went in to a c-section. It's a shame because it is the patients who could possibly suffer from the strike, but at the same time interns need to have funds to eat and pay rent. The strike is still going on a week later. No one is sure when it is going to end.