The hand-held ultrasound machine generously donated by the non-profit organization Youth Outreach Unlimited has already been invaluable! It is small enough to go with me on rounds to both hospitals in Blantyre and down south to Malamulo too. I have used it about a dozen times in the first week. And the amount of heart problems here is big! If I ever doubted that they could keep a cardiologist busy full-time…no longer! For those interested I have been keeping a rough tally of cases so far: the majority are cardiomyopathy (weakened heart muscle) of some type, hypertensive heart disease, right heart failure, palpitations, chest pain, and pericardial effusions (almost all of which are TB). In just the first week I have seen a probable case of severe mitral regurgitation from rheumatic fever, two cases of severe right ventricular failure, and cardiomyopathy from hyperthyroidism. So, the scanner is being put to good use! Thank you so much to all who donated toward the echo machine and hand-held ultrasound!
Monday, January 31, 2011
Orientation
It is the custom of the Malawi Medical Council to require an orientation and evaluation of physicians trained outside of Malawi when they first arrive. So, I have been assigned 6 weeks of orientation at a large government hospital here in Malawi. The hospital provides care, free of charge, to the public and serves as a referral center for the entire region. I cannot verify this statistic, but heard someone say there are about 250 physicians in Malawi, and 80 of them are at this hospital! The hospital is quite large with multiple medical wards.
My first day I accompanied a physician from Europe on rounds. Part way through I got sweaty and lightheaded. Sat down for a minute, the threw up. I, of course, stepped out. Unsure if I was ill from new food & water or from the overwhelming suffering surrounding me, I drank some tea and walked around again. This time more aware of how much my body had been filtering out the first time. The sounds and smells. There is a shortage of beds and of nurses, continually. There is no central cafeteria or kitchen. So, instead, there is space around the outside of the wards for family to camp, and they provide most of the meals and care for their loved one, the patient. So, the wards that are already over-crowded with patients, are also filled with family members attending to the needs of the sick. Still not feeling well, I rested for a minute and then called for a ride back to the hotel early. I had fevers, chills, and muscle aches through the afternoon and into the following day.
Slowly, I improved enough to head back to the hospital late in the afternoon the second day to do a cardiology consult as requested for an older man who presented with a large stroke and had been found to have severe hypertension and an irregularly irregular radial pulse. An ECG had been done, one lead at a time, along a long thin strip showing atrial fibrillation. I did a cardiac ultrasound at the bedside that showed an enlarged left atrium of the heart and thickened heart muscle consistent with affects of long-term high blood pressure. Treatment is with medications to lower the blood pressure and aspirin to reduce the risk of another stroke, which they can obtain (free of charge) 30 days supply at a time from the hospital pharmacy. Unfortunately, of course, the choice of medications is limited and intermittently out of stock.
I have now spent a total of 1 week on orientation there. I am amazed by the amount of true sickness and poverty on the wards. It is very different from my other experiences, even time spent at other (albeit private) hospitals in Africa! I’ll spare all the readers the medical details…but it is quite sobering. Meningitis, TB, profound anemia, malaria, and HIV are very common. Sometimes all in one patient! I need to continue to refresh myself on Tropical Medicine…bacteria, virus, protozoa, helminthes! And diagnosis/treatment with limited resources. But, the physicians I have been orienting with inspire confidence in the power of the clinical acumen from history & physical exam! They seem very capable of initiating treatment for these severe illnesses with a few lab & radiology tests. And then broadening treatments and testing as needed for those who do not improve. (However, given the sobering statistics on Wikipedia about Malawi, there must be many who do not make it in for treatments, or who can’t continue with the full treatment, or in whom with such advanced disease that treatments are merely palliative.)
Remodeling
One of the first things we found out here is that the house we will be staying in isn’t ready for us yet. The hospital CEO has been eliciting help from the other physicians and their wives to get the house ready for us. The most wonderful thing they have done is added a bathroom! The house is 3.5 bedrooms and had only 1 full bathroom. Just in the last two weeks they have added a very nice master bathroom.
They also had plans to redo the kitchen counter tops, the living & dining room floors, and the inside paint! They were just waiting to surprise us and have our input on the final choice of colors etc. Apparently, the house we will be renting is the 4th house to get some updates and the plan is to slowly continue to update all the houses owned by the hospital! We know they want us to feel at home, and stay in Africa forever! They also say, that keeping up the houses is good for resale value of the homes, so we are glad be involved in the upgrade.
They also had plans to redo the kitchen counter tops, the living & dining room floors, and the inside paint! They were just waiting to surprise us and have our input on the final choice of colors etc. Apparently, the house we will be renting is the 4th house to get some updates and the plan is to slowly continue to update all the houses owned by the hospital! We know they want us to feel at home, and stay in Africa forever! They also say, that keeping up the houses is good for resale value of the homes, so we are glad be involved in the upgrade.
While this is a very nice surprise for us, it also means we are staying in a hotel for a few weeks. The hotel they picked for us is very nice: within walking distance to the hospital still, and we have the use of a pool, access to the internet while in the lobby, and use of the hotel kitchen for cooking. We even got to make a few Skype phone calls home this week! Though, even here, the electricity & internet have been off a couple of times for several hours.
It has also sparked some internal debate about cost. We are trying to walk the (fine?) line between graciously accepting their offer; honoring the desire to put their best foot forward versus remembering that we are here to serve not to be served. So, though I find it moderately distressing, I have been convinced that the hospital is using a small part of their funds to maintain the houses they own, and part of that means a new bathroom and kitchen for us to use!
Since I have been in the hospital most days, Darryl is supervising the remodeling of the house. We hope to get it finished in time for the container with our furniture to arrive. We have learned that it crossed the ocean safely and has landed in South Africa. They say it is headed overland toward Mozambique!
Sunday, January 30, 2011
The Warm Heart of Africa
We left Orlando, Florida around 8pm with our 6 50-pound suitcases. Mental note to never move to another continent with that much luggage again. Jet Blue airlines was very accommodating about the luggage and graciously accepted our letter requesting exemption for extra baggage as we were carrying medical equipment for humanitarian use. We got only a brief 2-hr nap at JFK airport before flying out to Cairo, Egypt. Given the choice of 6, 30, 54, and 78 hr layover in Cairo…we chose to take the latter and a friend insisted we stay with his mother. This was our first encounter with the “warm heart of Africa.” We were treated wonderfully and felt very safe. Our taxi driver was recommended to us by our hostess and he drove us around Cairo for 2 days. Admittedly, we stayed mostly in tourist areas (the Pyramids of Giza, the Egyptian museum, the Citadel, the Cave Church etc) but did spend half a day exploring Heliopolis on foot.
Then an overnight flight south to Blantyre, Malawi where we arrived together with all 6 pieces of our luggage around noon the next day!
Then an overnight flight south to Blantyre, Malawi where we arrived together with all 6 pieces of our luggage around noon the next day!
We were immediately welcomed to the official “Warm Heart of Africa” as Malawi is known. Special thanks to all those who welcomed us so warmly in both Blantyre and Malamulo those first few days. We were invited to several “welcome” parties and invited over for dinner to many people’s homes. We indeed felt we had landed in the warm heart of Africa. Special thanks also to our new friends the Haytons, who moved to Malamulo Mission Hospital in September, and met us just off the airplane with all the things we would need for the first few days of living out of suitcases in a new place…bottled water, some snacks, fresh fruits & veggies, dry goods, soap, detergent, and some wonderful homemade bread! Sharlene thought of everything!
Wednesday, January 19, 2011
Monday, January 17, 2011
Learning to use the echo machine
Some pictures of getting and then learning to use the new echo machine. Special thanks to all the friends and family who donated money and time towards getting it! Especially those at University of Utah, in Loma Linda, at Helme's fundraising party, from the National Auxiliary, and Adventist Health International who donated time & money to make it possible...and those at GE who provided a great price for our humanitarian project!
Tuesday, January 4, 2011
A first world city inside every third world one
Darryl and I are sitting in our hotel in Orlando, Fl. We spent Christmas with my mom & cousins in Roseburg and Bend, Oregon. Then flew here for some R&R on our way to Africa. As we contemplate the idea of "luxury vacation" our thoughts turn to the socioeconomic divide in Malawi. We are grateful to our parents, who shared their timeshare points with us for this lovely luxury hotel. The kitchen in this hotel suite is nicer than the kitchens in the first three apartments we lived in after we were married! Imagine!! And two TV's... we haven't even had that in our nearly 6 years of married life.
Today while searching the internet for a cell phone in Malawi, I stubbled across a very interesting article by Martin Lucas on this website: http://www.mobileactive.org/one-laptop-child-v-cellphones-view-malawi. He writes an interesting opinion of Malawi as one who is there to help. And he touches on some excellent points. It is a long read...I actually read the whole thing out loud to Darryl while he made lunch...but worth the time. One of the things that stands out is his reference to the "post-globalization dictum" that there is a first world city inside every third world one and a third world city inside every first world one! Darryl and I have been talking about this concept for a while, but didn't realize someone else had put a name to it.
I will be moving to Africa as a physician ... but I don't think it will be like the stories we've heard of mission doctors to Africa from the last century. I will be living in a city. In a normal looking house. Probably on the row of elitist hilltop homes Mr. Lucas references. I will have internet access and a trip back home to the United States every year. And I'll have a computer at work. And one of my goals is to be able to provide care to a city that has both "first world" and "third world" inhabitants in the backdrop of one of the poorest countries in the world.
The need is so great...Malawi is said to have the lowest doctor-to-patient ratio in the world. One physician for every 60,000 Malawians! How do you even begin to care for 60,000 people as a single person? Blantyre, where we will be living, has over 700,000 people and I will be the only cardiologist. There must be a balance between seeing the middle & upper class who have health insurance or pay cash; and seeing the very poor who cannot afford even the free health care provided at Queen Elizabeth Hospital because of time and travel costs to get there.
Food for thought, a Gedanken experiment if you will, for those following along...think about which parts of your own current city of residence are "third world" versus "first world." As I think of the two places we lived most recently, Salt Lake City, Utah and the Inland Empire, California, I think there are definitely parts that qualify as third world. I hope as the US pulls out of the recent economic downturn, those places are addressed.
Tiffany
Today while searching the internet for a cell phone in Malawi, I stubbled across a very interesting article by Martin Lucas on this website: http://www.mobileactive.org/one-laptop-child-v-cellphones-view-malawi. He writes an interesting opinion of Malawi as one who is there to help. And he touches on some excellent points. It is a long read...I actually read the whole thing out loud to Darryl while he made lunch...but worth the time. One of the things that stands out is his reference to the "post-globalization dictum" that there is a first world city inside every third world one and a third world city inside every first world one! Darryl and I have been talking about this concept for a while, but didn't realize someone else had put a name to it.
I will be moving to Africa as a physician ... but I don't think it will be like the stories we've heard of mission doctors to Africa from the last century. I will be living in a city. In a normal looking house. Probably on the row of elitist hilltop homes Mr. Lucas references. I will have internet access and a trip back home to the United States every year. And I'll have a computer at work. And one of my goals is to be able to provide care to a city that has both "first world" and "third world" inhabitants in the backdrop of one of the poorest countries in the world.
The need is so great...Malawi is said to have the lowest doctor-to-patient ratio in the world. One physician for every 60,000 Malawians! How do you even begin to care for 60,000 people as a single person? Blantyre, where we will be living, has over 700,000 people and I will be the only cardiologist. There must be a balance between seeing the middle & upper class who have health insurance or pay cash; and seeing the very poor who cannot afford even the free health care provided at Queen Elizabeth Hospital because of time and travel costs to get there.
Food for thought, a Gedanken experiment if you will, for those following along...think about which parts of your own current city of residence are "third world" versus "first world." As I think of the two places we lived most recently, Salt Lake City, Utah and the Inland Empire, California, I think there are definitely parts that qualify as third world. I hope as the US pulls out of the recent economic downturn, those places are addressed.
Tiffany
Monday, January 3, 2011
R & R
Pictures from our rest & relaxation time before moving to Malawi. We spent time with family in Roseburg & Bend, Oregon and Orlando, Florida and Freeport Bahamas.
Subscribe to:
Posts (Atom)