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Day 13: Weekend Trip to Zomba Plateau and Lake Chilwa

Woke up reasonably early and left with 2 of the guys from MSU, an ortho resident from Boston and a female med student from London. The other 5 MSU students had left for the plateau the day before. Using the orthopedic resident's car, one of the guys drove, as it is a manual. I really should learn to drive stick shift when I get back to the States. My old driver's training instructor told me that if I wanted to live to the age of 25, I wouldn't drive a stick. Well, I'm 25 now, so perhaps it is time to try again.

We drove through the countryside until we saw Zomba Plateau in the distance. When we reached the plateau, we drove up many switchbacks until we reached our destination: Trout Farm. Going up the mountain was slightly terrifying, due to my little fear of heights, especially as some of the roads didn't have guard rails.

Trout farm is a lodging area and we were able to get a beautiful, hand crafted, wooden lodge for the 5 of us. The place had running water, but no electricity. We didn't waste any time getting a guide to begin our trek to the top of the plateau. Our guide's name was Friday and he led the group barefoot up the mountain. My body was definitely not used to the altitude or climbing steep inclines (Michigan is quite flat). Soon I was huffing and puffing. I was definitely the least athletic out of our group of cyclists and marathon runners. It was a struggle to get to the top. But with a little encouragement, determination and quick stops to catch my breath, I made it to the top. The view was worth it, as we could look out over towns and the rest of the landscape. We were up in the clouds.

Our trek down was not as strenuous, but more mentally taxing and balance taxing, as it was slippery. Friday took us to more look out points where when we looked down, all we could see were clouds. He also took us to a waterfall. Once we made it back after our 6hr hike, we made egg sandwiches on the gas stove and watched the sun set from the porch. Candles were it and a fire was made outside. We looked up at the stars and joked about our near future as interns.

The next morning we packed up and drove to Lake Chilwa, which was nearby. We were told the road was "off the beaten path" and sure enough with all of us piled in the car, we had about a 3 inch clearance from the ground and potholes. Needless to say, it took awhile to get there. But as we passed through villages, we got even more of a look at the culture of Malawi. When we hit the lake, we got out, stretched, took pictures, and hopped right back in. It was a very hot day and by that point in time the trunk would not latch. Yay for rope. We didn't do the boat ride on the lake, because we didn't want to leave the trunk and stuff unattended. We drove back and compared notes on our different experiences with the other 5 when we got home.


Day 15: Starting a week in the Special Care Ward

After sniffing our clothes and smelling something rank, the men took apart the dryer intake and found a dead snail! They fixed it up and our clothes are back to normal smells.

On Monday, I started on the Special Care Ward, which is where acute pediatric cases go after A & E (accident and emergency). We started rounding in the High Dependency Unit (aka ICU) and saw gastroenteritis (viral illness causing vomiting and diarrhea), a girl with hemiplegia awaiting an MRI (half side of her body wouldn't work), vocal cord papilloma, dehydration and shock, etc.

In the afternoon, I went to A&E again to the Resuscitation room. They pack as many kids in as they can onto the 4 beds, usually with two patients per bed. One patient was unconscious with a 3rd nerve palsy (one of her eyes pointed down and out), decreased reflexes and history of convulsion (seizure). I checked her sugars, which were normal. We weren't sure if it was due to malaria, a lesion in the brain, meningitis or something else. She was sent to the Malaria Research Ward. A couple days later, I found out that she had meningitis and came back around with antibiotics. Everything else was negative.

Other children had SMA (severe malaria anemia) and needed blood transfusions. To diagnose anemia fast, we compared the hands of the child with the hands of the mom. We felt for enlarged livers and spleens, which seem to be quite common here.

When kids don't cry when examining them or resist IVs and shots, then you know they are exhausted and pretty sick. These are the kind of kids that end up in the Resuscitation room.

Another girl was lying against the wall coming in and out of consciousness and coherent thoughts. She had her eyes closed and was curled up, refusing to be moved. We sent her to the Special Care Ward, where I found out the next day that her LP (lumbar puncture) was positive for strep pneumonia. She looked completely different since she had received her antibiotics. I almost didn't recognize her because she looked so much better. But I remembered her name: Memory.

Went to a palliative care lecture that night, which was informative. Still trying to get used to the different drugs names here. (Paracetamol = acetaminophen (Tylenol)).




Day 16: Wow...just wow.

Following up on some of the patients, the girl with hemiplegia was found to have a craniopharyngioma on her MRI. Basically this means she had a growth in her brain that was able to be removed.

We saw a 5 year old with enlarged lymph nodes everywhere. They were under her chin, on the back of her head, in her armpits, on her back and in her groin. She was later diagnosed with HIV. Questionable TB.

Another child that had HIV had a CD4 count of 1. Normal is between 500-1600. Additionally, I saw a 5 month old with Transposition of the great arteries (the aorta and pulmonary arteries are switched from where they are supposed to be). Most kids with this die almost immediately, but this one was able to live because of a hole where the blood could be mixed. We think he had a PDA that remained open after birth, but his chest sounded like he had a VSD.

When I got home, I learned that one of the others had an even more eventful day. He had previously seen a very poorly done c-section where the interns were operating without an attending supervision. The colon had been accidentally cut a couple of times, the patient bled and died later that night. After seeing this, one of the med students from our group (who wants to go into OB/Gyn and has had several rotations of it), took charge of a c-section because he couldn't stand the poorly done procedures. And in all honesty, he had more experience than the interns who were operating. So with the intern at his side, he cut, delivered and finished an entire c-section without any complications.

They don't resuscitate infants properly here (i.e. no suction of the airways, and no rigorous stimulation to arouse the infant. So he looked for the other student on (who knows pediatrics) and she was unavailable because she had passed out from the heat of the OR.

The story continued when he told us that the ORs don't have suctions to suction blood out of the operating field of vision (the incision and womb). When he was done, he realized that blood had seeped through his scrubs and onto his leg and groin. The patient was known to be HIV +. The student is now on HIV prophylaxis meds, although it is extremely unlikely that he would contract HIV in that manner. It was a good reminder to us to be careful while being here. And the medical supply box finally made it to Malawi.