Thursday, July 29, 2010
A typical work day
A typical work day. Today I got up around 6am, no need to use my alarm clock (that tells the temperature, too, I love it!) because I tend to go to bed pretty early—last night I lasted all the way to 10:30. Anyway, the sun rises around 6 and the cacophony of birds and dogs and people begins. I have some tea and usually a bowl full of tomatoes and off to work, usually by 7:30. Today I frantically uploaded weekly surveillance databases—measles never stop here in Malawi! I send these databases to a HUGE group of very important people who likely hit the delete button when they see the data arrive. In NYC it would take about half a minute to upload the data, write a brief explanatory note and hit send. Here it takes about half an hour and three to four emails to get this info on its merry way—on a good day! I also had some correspondence and information to share with local district health officers, all the while hoping that the electricity would stay on. It did! After my internet frenzy, I spoke briefly with Laura the Medical Focal Point (you’ve got to love people’s titles) trying to set up future research projects for English Emma, the epidemiologist associated with the long term HIV project. I’m here with an emergency team for the measles epidemic. Epidemiology is new to MSF and they don’t really know about the tools of our trade, so I spent time lobbying for the computer programs required to do our work. I’m hoping that the analogy of sending doctors to places without drugs is an effective one to describe our plight. Software=drugs, so far they’re not buying it. Maybe all of the epidemiologists will have to join forces and create Epidemiologists without Borders! Yeah, I like it!
My hectic morning completed, I’m off to Mulanje: the land that internet forgot. Mulanje is situated high on a plateau beneath an imposing mountain that shoots straight up out of the ground. It is the highest in Mulanje and the local people advise us not to climb it because people leave to climb it and are never heard from again. The mountain itself is lush and green until about halfway up, after that it’s covered with tea plantations, but also with bananas, palms and eucalyptus trees, then it is sheer gray cliff to the top, streaked by the occasional waterfall. It’s about an hour drive away from Thyolo and it is down hills and up even steeper hills until we hit the plateau. We get to the unlikely turn off and climb the road that looks like a recently dry waterfall, all red mud and rocks, past the prison where they play lots of soccer and finally to the MSF Mulanje house overlooking the tea plantation. I’m read a technical report to learn everything you never really wanted to know about measles and then I’m off with Heike, the German doctor from Sweden, who takes me on case management rounds to the ‘beautiful’(!?!) parts of Mulanje. Case management consists of visiting all of the local health facilities, donating drugs to support the treatment of measles and collecting the line lists of all of the patients who visited the health facility the week before. We speak with the doctors to discuss the upcoming national vaccination campaign, any interesting cases and anything else that crosses anyone’s mind. They are very social here in Malawi and it often takes several minutes for everyone to say the standardized and comprehensive hello. (Hello, how are you today? I’m fine, and you? Oh, I’m fine too, thank you very much for asking. No, thank you for asking...)
Of course, I did have some work to do and I could have worked on my computer for the rest of the afternoon. I could have, but Heike just whisked me away in the toughest four wheel drive vehicle on the compound, a pick up truck to hold the drugs we bring to the health facilities. We were smushed the three of us in the front seat: me, Heike and the driver and we make a left turn at the pineapple stand, (the one with the best pineapples) and from then on it is all uphill on rough, red, rugged roads (making the home road look paved in comparison). There are tons of pineapple groves, but the season has ended. This is the only place in the country that still has the last of the season and these are only the ‘suckers’ little pineapples that pop up where the big one has already been harvested. They are still quite sweet, so I have absolutely no complaints and plan to buy some to bring up to the north when I move back up there.
It’s overcast today, so the gray sky and mountain make everything look greener. We pass a ton of school children in uniform and really piss them off because they want to climb in the back of the pick up truck instead of making the steep climb up hill to their homes. We’re strictly forbidden to give people lifts in company cars, so these adolescents trying to be cool, but they couldn’t help themselves as they waved and waved and shouted out hello. After we leave the school children behind on our way to the first of the three health centers we are to visit, we start hearing cries of Ázungu! Azungu!’ (White people! White people!), a refrain we hear for the next two hours. People are so excited to see us and everyone waves, even the adults, even the old people. Looking at the condition of the road and the fact that we didn’t pass a single car our entire way up one side of the mountain and down the other, I’d guess that pretty much anyone who passes is a source of major amusement. At the first health center there are tons of children—that I jokingly said were waiting to get vaccinated. At the second were three beautiful women at the pump in the distance, the color of their plastic water containers matching the color of their sulas (cloth wrap skirts), framed by the mountains behind. Our last stop is at a tea estate health center. I think the health center is entirely private, but I couldn’t really tell. We pass through the toughest barrier control yet (there are many on the roads control entry and access to the towns along the way). At this one, however, the driver has to sign in before we could pass. It’s pretty much run like an independent country. There exists workers housing, a private club for the staff, there are road markers at each crossroads (unlike any place else in Malawi!), plus of course the quite nice health facility.
When we get back, I do a little bit of analysis while sitting on the veranda with a magnificent view of the valley and mountains beyond (the best office I’ve ever had!), prepare a presentation of the measles epidemic in Mulanje to be given at the district hospital medical morning rounds tomorrow at 7:30am and call it day!
My hectic morning completed, I’m off to Mulanje: the land that internet forgot. Mulanje is situated high on a plateau beneath an imposing mountain that shoots straight up out of the ground. It is the highest in Mulanje and the local people advise us not to climb it because people leave to climb it and are never heard from again. The mountain itself is lush and green until about halfway up, after that it’s covered with tea plantations, but also with bananas, palms and eucalyptus trees, then it is sheer gray cliff to the top, streaked by the occasional waterfall. It’s about an hour drive away from Thyolo and it is down hills and up even steeper hills until we hit the plateau. We get to the unlikely turn off and climb the road that looks like a recently dry waterfall, all red mud and rocks, past the prison where they play lots of soccer and finally to the MSF Mulanje house overlooking the tea plantation. I’m read a technical report to learn everything you never really wanted to know about measles and then I’m off with Heike, the German doctor from Sweden, who takes me on case management rounds to the ‘beautiful’(!?!) parts of Mulanje. Case management consists of visiting all of the local health facilities, donating drugs to support the treatment of measles and collecting the line lists of all of the patients who visited the health facility the week before. We speak with the doctors to discuss the upcoming national vaccination campaign, any interesting cases and anything else that crosses anyone’s mind. They are very social here in Malawi and it often takes several minutes for everyone to say the standardized and comprehensive hello. (Hello, how are you today? I’m fine, and you? Oh, I’m fine too, thank you very much for asking. No, thank you for asking...)
Of course, I did have some work to do and I could have worked on my computer for the rest of the afternoon. I could have, but Heike just whisked me away in the toughest four wheel drive vehicle on the compound, a pick up truck to hold the drugs we bring to the health facilities. We were smushed the three of us in the front seat: me, Heike and the driver and we make a left turn at the pineapple stand, (the one with the best pineapples) and from then on it is all uphill on rough, red, rugged roads (making the home road look paved in comparison). There are tons of pineapple groves, but the season has ended. This is the only place in the country that still has the last of the season and these are only the ‘suckers’ little pineapples that pop up where the big one has already been harvested. They are still quite sweet, so I have absolutely no complaints and plan to buy some to bring up to the north when I move back up there.
It’s overcast today, so the gray sky and mountain make everything look greener. We pass a ton of school children in uniform and really piss them off because they want to climb in the back of the pick up truck instead of making the steep climb up hill to their homes. We’re strictly forbidden to give people lifts in company cars, so these adolescents trying to be cool, but they couldn’t help themselves as they waved and waved and shouted out hello. After we leave the school children behind on our way to the first of the three health centers we are to visit, we start hearing cries of Ázungu! Azungu!’ (White people! White people!), a refrain we hear for the next two hours. People are so excited to see us and everyone waves, even the adults, even the old people. Looking at the condition of the road and the fact that we didn’t pass a single car our entire way up one side of the mountain and down the other, I’d guess that pretty much anyone who passes is a source of major amusement. At the first health center there are tons of children—that I jokingly said were waiting to get vaccinated. At the second were three beautiful women at the pump in the distance, the color of their plastic water containers matching the color of their sulas (cloth wrap skirts), framed by the mountains behind. Our last stop is at a tea estate health center. I think the health center is entirely private, but I couldn’t really tell. We pass through the toughest barrier control yet (there are many on the roads control entry and access to the towns along the way). At this one, however, the driver has to sign in before we could pass. It’s pretty much run like an independent country. There exists workers housing, a private club for the staff, there are road markers at each crossroads (unlike any place else in Malawi!), plus of course the quite nice health facility.
When we get back, I do a little bit of analysis while sitting on the veranda with a magnificent view of the valley and mountains beyond (the best office I’ve ever had!), prepare a presentation of the measles epidemic in Mulanje to be given at the district hospital medical morning rounds tomorrow at 7:30am and call it day!
Wednesday, July 28, 2010
Me! Me! Me!
Everyone keeps asking for a picture of me, so here it is! Yes, I am still mighty alive and on this particular day having my first viewing of Lake Malawi--which is big enought to have waves and a really strong current!
Tuesday, July 27, 2010
July 28--EARLY
On the road again--and off to places where no internet has gone before. As the traveling epidemiologist for the emergency measles outbreak investigation and intervention in Malawi, I travel A LOT! I move every few days and spend a lot of time on the road. These are just a few of the things I see out there. More news later. I can tell it's going to be a beautiful day in Malawi--if only winter was like this in NYC!!!
Monday, July 26, 2010
I saw my first funeral the other day, driving down from Lilongwe VERY slowly with my new, non-English speaking, non-music owning driver when suddenly a crowd of 100 people suddenly materialized on the road. The women were brightly dressed in cloth wrap skirts and matching head wraps, the women in front marching purposefully, the men in worn western dress straggling in a group behind them. The car in front of us slowed down driving through the crowd and my driver, when asked, told me it was probably a funeral. We even spotted the cemetery as a few people wandered down the hill, clearly members of the funeral party. I’ve seen many signs for coffin makers—Buy and Fly coffin makers, Heavenly Rest and yesterday on the road from Limbe to Zomba, six men were carrying an elaborately designed and lacquered coffin down the side of the road. There are occasional HIV prevention signs and I even saw a billboard for female condoms in Blantyre (the NYC and economic capital of Malawi) in this country of 20% HIV prevalence. But the clearer signs of devastation are the huge number of coffin makers and occasional signs to register children to avoid child exploitation. (I was advised that a pilot program is going on in Blantyre to have a birth registry, death registers are unthinkable at this point, though the District Health Officer in Lilongwe did try to finesse their lack of existence.)
The other thing that is plentiful are the orphanages. They are everywhere of signs for them. Yet I have never seen children hanging around these places. There are tons of schools as most of the population is under 25 (life expectancy is 41 years) and here children can be seen, but in my privileged trips around the southern part of the country, I’ve noticed that many of the schools appear to be empty.
Bicycles are everywhere. People—ok only men—ride them along the main highway, the M1. I asked my driver if there is an M2. There is not. The main roads are pretty good and filled with people and trading centers. It is rare to hit a stretch of road where there are no people. The men rid their fully laden bikes in this hilly, make that mountainous, country and they often walk them up hills, since the bikes are a major form of transporting things: wood, metal roofing, food, charcoal, you name it is strapped on to the bicycle and appears to be hanging on for dear life.
The idea of abundance. There are certainly people in abundance in this densely population country, which pretty much everyone is quick to point out is one of the poorest in Africa. It is so interesting to go to the market place to see people selling things on the side of the road. The bags, packaging or even the artfully arranged piles of food or goods are simply exploding and threatening to spill out everywhere. There is a tendency to display and to buy and sell a lot, as if that is a measure of prosperity when in all likelihood it is a measure of the lack of selling containers.
One of the standard personages I have seen at the market place is a teenage boy who carries a long stick across both shoulders on which is nailed a selection of various sized plastic bags like those from a supermarket though these are most often black or blue, while the charcoal bags are of a tough white plastic that always remains white despite the blackening contents. The charcoal is also woven into the top of the bags using pliable branches that may be some kind of palm.
There is an artistry of arranging things in beautiful yet practical ways so that nothing falls out, but it is beautiful to behold. I am in love with the fish market in Zomba. All of the fish are dried but the only ones not individually arranged are the anchovy like silver fish, though even these are often arranged so that the piles peak in the middle. None of the fish are very big and if my one sampling of the fish here is any indication, they are also very bony. My favorite fish is black—whether from being smoked and dried or naturally, I don’t know—but it has a rather prodigious tail that the fish vendors curl up into the mouths of the fish and then arrange in a series of bows to amuse shoppers passing by.
The other thing that is plentiful are the orphanages. They are everywhere of signs for them. Yet I have never seen children hanging around these places. There are tons of schools as most of the population is under 25 (life expectancy is 41 years) and here children can be seen, but in my privileged trips around the southern part of the country, I’ve noticed that many of the schools appear to be empty.
Bicycles are everywhere. People—ok only men—ride them along the main highway, the M1. I asked my driver if there is an M2. There is not. The main roads are pretty good and filled with people and trading centers. It is rare to hit a stretch of road where there are no people. The men rid their fully laden bikes in this hilly, make that mountainous, country and they often walk them up hills, since the bikes are a major form of transporting things: wood, metal roofing, food, charcoal, you name it is strapped on to the bicycle and appears to be hanging on for dear life.
The idea of abundance. There are certainly people in abundance in this densely population country, which pretty much everyone is quick to point out is one of the poorest in Africa. It is so interesting to go to the market place to see people selling things on the side of the road. The bags, packaging or even the artfully arranged piles of food or goods are simply exploding and threatening to spill out everywhere. There is a tendency to display and to buy and sell a lot, as if that is a measure of prosperity when in all likelihood it is a measure of the lack of selling containers.
One of the standard personages I have seen at the market place is a teenage boy who carries a long stick across both shoulders on which is nailed a selection of various sized plastic bags like those from a supermarket though these are most often black or blue, while the charcoal bags are of a tough white plastic that always remains white despite the blackening contents. The charcoal is also woven into the top of the bags using pliable branches that may be some kind of palm.
There is an artistry of arranging things in beautiful yet practical ways so that nothing falls out, but it is beautiful to behold. I am in love with the fish market in Zomba. All of the fish are dried but the only ones not individually arranged are the anchovy like silver fish, though even these are often arranged so that the piles peak in the middle. None of the fish are very big and if my one sampling of the fish here is any indication, they are also very bony. My favorite fish is black—whether from being smoked and dried or naturally, I don’t know—but it has a rather prodigious tail that the fish vendors curl up into the mouths of the fish and then arrange in a series of bows to amuse shoppers passing by.
Finally getting started!
Ok, it's about a month later and I'm finally getting my act together. When I came back from my Medecins sans frontieres training in Germany, I spoke with the local office who told me that there was NOTHING for the forseeable future and that I should just keep them aprised as to my availability. I was despondent!!! Until they called me less than 24 hours later to tell me that I was going to Malawi--in 4 days! This is what my apartment looked like.
Several days later and an unexpected yellow fever vaccine shot, I found myself in the most laid back of African countries, where I was greeted by a local delicacy: mice on a stick! I thought they were plants that the guys were waving on the road, but no, it was boiled field mice nailed to a stick. Yummy! Welcome to Malawi and the wonderful world of mosquito nets--even in winter.
Several days later and an unexpected yellow fever vaccine shot, I found myself in the most laid back of African countries, where I was greeted by a local delicacy: mice on a stick! I thought they were plants that the guys were waving on the road, but no, it was boiled field mice nailed to a stick. Yummy! Welcome to Malawi and the wonderful world of mosquito nets--even in winter.
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