Life in Blantyre, Malawi: April 2011

The last 6 weeks have been a little hectic. Tiffany’s dad came for a visit and helped us move from our hotel room into the house we are renting from the hospital! The remodeling wasn't quite finished yet, but it sure was nice to get into our own space!

Tiffany's dad also brought a few much-needed medical items (pulse oximeter, ECG leads, ultrasound gel, pediatric stethoscope, ambu bag). While he was here we took one night off to go on a Safari at Mvuu Lodge. We saw hundreds of birds, hippos, and various deer. A few crocodiles, elephants, monkeys, and warthogs.

Tiffany finished her orientation at the government hospital and started work at Blantyre Adventist Hospital. She has her own outpatient clinics for cardiology, internal medicine, and echocardiograms and have a few inpatients. She also sees a few in-patients / out-patients / ER patients being managed by our 4 general practitioners every day, usually it’s the harder, more complicated cases they want her help with. She has also been working on facilitating the final steps of constructing and equipping the ICU. And once per week we drive down to Malamulo Mission Hospital for a half day and see any clinic patients or in-patients they have lined up for Tiffany and do any echocardiograms they need.

But, we do take time once a month to leave town for a few hours to get a little break. Last month, we went for a picnic lunch in Nyala Park, a small private game reserve surrounded by a sugar plantation down in the Shire River Valley. It’s just over an hour away from Blantyre, and once we arrived the Haytons (from Malamulo Mission Hospital) and Monica and Emma (the two pediatric residents visiting from Loma Linda University) piled in our 10 seater for the tour around the park.

The workers finally completed the kitchen remodel! Looks great! Such an obvious contrast to what we know the majority of Malawians have for a kitchen.

The container with all our furniture arrived the last week of March, completing its nearly 4-month journey from Loma Linda, California that started on December 1^st. We only found 4 things that were broken…remarkable considering the thousands of miles over the ocean and hundreds of miles on African roads!

In March, I (Tiffany) also chaired the search committee for a charge nurse with 2 years of ICU experience to run the nursing side of the ICU. After advertising in the 2 most widely read national newspapers, we had only 3 applicants, two of which had not worked in an ICU before and the third didn’t live on this continent. We advertised again, for an entire week, in the national newspapers, on the radio, and with flyers around Blantyre. This time we received about 9 additional applications and invited everyone who applied to interview. I am very excited that the committee has offered the position to a qualified nurse who has worked in an ICU for several years before (not in Malawi as there are really only a few beds that are considered critical care beds here in Malawi, and thus the nurses here have very limited opportunity to see critical care medicine) and she has accepted! Now we are just waiting for all the paperwork to get processed. Next, between the two of us, we need to plan a curriculum to train 8-10 ward nurses in critical care over the next 6-8 weeks, to staff the ICU.

So, as you can imagine, we haven’t finished unpacking boxes and rearranging furniture yet. Still working on choosing a balance of time spent at work and time spent at home…and most of the time I never get anywhere near finishing the "to-do" list at work or at home and go to bed worried about things left undone, emails left unanswered, and patients who can't afford the treatments that they need.

This is an old Seventh-day Adventist Mission, one of the first in Africa I think. Very well laid out, set in the countryside of southern Malawi and surrounded by tea plantations. But with the shift of the population into cities there are fewer paying clients in the countryside and fewer still making the relatively long drive (1+ hour from Blantyre) to receive health care out here. And so Malamulo continues to provide high quality care to the thousands of poor patients in the region who can’t pay their bills. They have a large campus with the hospital & clinic, an elementary & secondary school, a printing press, a nursing school, and a therapeutic feeding center for malnourished children. On my once weekly trip I often do echocardiograms on children with murmurs to look for congenital or rheumatic heart disease.