November 13,2005
The moments (by Eddy)
The day I set foot in Malawi.
By Eddy Ang
洪志元
Meds 4
Kaohsiung Medical University
Foreword
It’s been almost a month since I got back from Malawi. Recalling the last one month, things went pretty well for me during my stay there. In fact, at the end of my stay I found it real hard to get myself into the state where I was more comfortable with the idea of leaving that country which is literally free from all sorts of pollutions.
I will try my best to organize all my thoughts so that you can get a clear picture of what I was doing in that country and how it was like being in a different region on the earth.
Before the trip…
l Vaccinations
We were told to receive one shot against the yellow fever and another against the meningitis. However, it was not until I bumped into a voluntary team from the UK in South Africa that I came to realize these two vaccines literally were of no use at all since Malawi is not an affected area. I was taken aback when the leader of this British team told me that we should be on our guard against the Hepatitis A and the rabies instead of the two aforementioned diseases. What a drag!
So, our team was very alert when seeing dogs on the street. Rabies is no laughing matter, its mortality rate is close to 100% I’m telling you. Well, I couldn’t help but wonder, why were we told to get those useless vaccinations in the first place? How could it be that no one knew what kind of vaccinations to receive? I’m really puzzled.
Well, at least now I can give those who are going next year a few pointers. Be sure to get yourself armed with the Hepatitis A and the rabies vaccines. Don’t overlook it again.
l Research
Other than the medical aspect, we did a lot of research on the tough issues going on in Malawi. To sum up, we were drawn into three main topics:
1. Poverty
2. Disease
3. Culture and Taboos
Missions and Tasks
Long before we actually set off for Malawi, a couple of tasks had already been assigned to us. Let me try to put things in a nutshell now. One is the setting up of the intranet for the Mzuzu Central Hospital. Another task is to sort out the messy and unorganized medical records. The last mission came to the observation and inspection on how things were operated at the ARV (Antiretroviral) Rainbow Clinic that dealt with the HIV patients.
l Setting up the intranet
The network setup was not too tough with the help of Ryan who was also the one and only engineer at the hospital. We first spent some time meeting up with the heads of the different departments to let them know we were on our way to setting up the network for them. So, we were basically building up the ideas and evaluating what was the best way to make the network work without putting them out too much.
Therefore, most of the hard work that included the climbing up and digging down was accomplished by the local workers there. A bunch of thanks go out to them! They were pretty helpful but since this was not the mission I was working on I’m not going to go any further on this.
l Arranging the medical records
The highlight of my mission came from the acquaintance with 3 other local coworkers at the Medical Record Room. They were Isaac, Wees, and Judy. Isaac and Judy were in charge of entering the medical record data into the 2 computers we had there while Wees was the one organizing the medical records accordingly. Before we joined forces in sorting out the medical records, they were actually organized according to the home address of the patients. We thought it wasn’t very effective for the medical staffs to retrieve the relevant data if it worked in that way. We sort of had a very hardcore discussion with the head of the record room, and he eventually came to an agreement to our ideas which sadly turned out to be not so effective either.
This was when we all finally put all the records into the correct order. What a job! You can tell our feelings by the look of these 2 gals, it’s a super complicated feeling mixed with a sense of satisfaction and tiredness.
l Clerkship at ARV Rainbow Clinic
The other interesting part that drew my attention was the rotation at the ARV Rainbow Clinic. It was the first time in my entire life to witness so many people suffering from the HIV threat. All the patients had to go through a series of mental counseling before they were given drugs to fight against the virus. They were counseled to practice safe sex (which includes the use of the condoms) as well as remain faithful to their marital partners.
People there were seeking hopes. They knew their health was deteriorating and their condition could only get worse if they refused to turn to the medical help. I wouldn’t say it was a salvation as AIDS is still incurable in the human race. But rather I thought it was more of a comradeship that was provided by the Rainbow medical team that really helped the patients.
There was this doctor who greatly impressed me. His name is Paul. Every time after he finished checking on his patients, he would pick a verse from the Bible and asked a local nurse to translate the biblical ideas into their native languages. In so doing, patients not only received physical help but also mental solace from the consultations.
A close-up I took on the entrance of the Rainbow Clinic. The reason they named the AIDS clinic this way is to prevent discrimination from the non-HIV people. Another clinic I heard of is called “Lighthouse”, which also gives a very positive meaning.
Dr. Paul was performing an Oral Quick Test on me. It was kind of new to me. This test is to indicate if the person is HIV-positive or not.
Here goes the result! If the red line hits the letter “C”, it means the person is HIV-negative! Dr. Paul made fun of me, saying that I should carry this picture along on a blind date to prove I am not an HIV carrier.
Transportation, Accommodations, and Meals
Everything was so cool. We had the best cooks and the best drivers in the Mzuzu City. They were friendly enough to make our lives so much easier. Of course, one thing to note, the Taiwan Medical Mission team was like our guardians all the way. Here I would like to dole out my utmost gratitude to Dr. Chen (陳厚全醫師). He was being so nice from the very beginning of our trip. He definitely made the best babysitter I’m sure. So, yeah, we also had the best babysitter in town! He was so inspiring, I might add, he was always an inspiration supplier to all of us. He never ceased to enlighten me with his own thoughts and most of them became the main sources that kept me thinking and introspecting most of the time.
l Transportation
Transportation is always the main concern in Malawi. The locals had the minibus but we were not allowed to get on it since it was not a safe means to get around the city. I would love to start out describing this interesting minibus. It is the most common way for the locals to commute back and forth between work and home. Every minibus that I saw on the street was almost on its last legs. From the look of it, just a fender bender was more than enough to make it fall apart. To add insult to injury, each minibus was always jam-packed with over 15 people at a time.
This is the most amazing vehicle I’ve ever seen in my entire life. It’s Minibus! See how we were all squeezed and sandwiched among one another. But it was a lot of fun, too!
l Accommodations
We were arranged to stay with the Taiwan Medical Mission. Lucky enough! This hostel was built by Taiwanese Ministry of Health sometime back. I’m not sure of the exact time, though. But it’s super sturdy compared to the local accommodations there. We had sufficient daily commodities in the missionary team, such as the heater for a hot shower, as well as mosquito nets just in case.
As you can see from the picture above, this is where we all lived in for the past one month in Mzuzu. The Taiwan Medical Mission rocks!
l Meals
We had the best meals every day! Our three amazing cooks, Duncan, Rose, and Eunice are the best there are in town! They’re pretty well trained by the Taiwanese there and so they could always come up with authentic Taiwanese food. Although the majority of us in the team enjoyed the food to the core, they never got the nerve tasting Taiwanese food. After having tried out Malawian local food, I would say I still prefer Asian cuisines.
However, local people could never have the privilege to enjoy a sumptuous and hearty meal like we always did. Their main dish is called “Nsima”, which is made up of the maize flour, then added with some water. Stir it until it gets very sticky. And it’s ready to be served! I’m telling you, eat it barehanded. I tried a bite on Nsima before, unfortunately it didn’t quite hit the spot! Haha…
The majority of the population there didn’t get sufficient nutrition a lot of time. That’s why malnutrition is a big issue that many foreign voluntary efforts are working against. From what I heard, I knew most people only ate one meal in a day. For most of them, breakfast was nothing but a plain tea. Lunch was usually skipped. And Nsima was the most proper thing they had for a day’s meal. I was pretty overwhelmed by their perseverance in life. They were left with no choice but to get by every single day optimistically.
The cooks: Rose and Eunice. Where is the chief cook, Duncan?
This is how they set up the fire and start preparing for a meal.
Without a doubt, this is the maize flour that serves as the main dish for the locals.
The one of a kind, legendary Malawian food. Nsima!
What does the Medical Missionary Team do?
I wouldn’t go so far as to say I’m very familiar with each member’s duty and responsibilities, but this is the brief picture I got from them during my stay. I was pretty much impressed by the medical team there because each and every one of them was so creative and flexible in times of confusion. We’re kindly adviced not to make plans in Malawi, for fear of giving others blank promises as well as disappointing ourselves when we fail to keep up with the schedule. Let’s start out with an introduction of the members.
Duty | Members |
Leader of the team | Dr. Joseph |
Orthopedist | Dr. Chen |
Internist | Dr. Ron |
Pediatrician | Dr. Bong |
Pharmacist | Ms. Judy |
Engineer | Mr. Ryan |
Nurse | Ms. Yen |
Nurse | Ms. Janny |
替代役男 1 | Conga |
替代役男 2 | Dr. Paul |
替代役男 3 | Jerry |
Pathologist (British) | Dr. Alex |
l ARV Clinic
Basically it’s run by Dr. Joseph, Dr. Paul along with Ms. Yen. While Dr. Joseph and Dr. Paul take care of the consultation and prescription, Ms. Yen is in charge of the dispensary. Each patient will be given medications only after they have received the Health Education(衛教). This education part provides the patients with the correct concept of living up better life. The use of condoms and the practice of safe sex are strongly advocated in hopes of preventing AIDS from spreading around any further.
Dr. Joseph and me at the Johannesburg International Airport, South Africa.
l Mobile Clinic
This is something very new to me. Dr. Chen and Dr. Bong are the main forces. Due to the fact that some parts of Malawi are almost devoid of medical service, they came up with this idea of traveling once or twice a month to those backward areas. A lot of times, the traveling itself was tiring enough. However, when I looked at the doctors, some thoughts struck my head and said it’s the wiling hearts that made things happen!
l Drugstore
Ms. Judy is a great one! She made sure the storage of drugs went on the right track and those things that came along with it. She’s so energetic that I told myself to look up to her as a medical staff-to-be. To my surprise, she also edited a “drug manual” for all of the hospitals in Malawi. Thumbs-up for her!
l Pediatrics
Dr. Bong is the one and only pediatrician. I really lucked out and got a chance to witness the process of the consultation. Those stuffs that I learned in class were slowly recalled and he was patient enough to guide me along the consultation. Most kids being treated there were the victims of AIDS. Transmitted vertically from their mothers, they were born to be an HIV carrier.
l Internal Medicine
Dr. Ron is really good at internal medicine. In fact, I was greatly impressed by his experience and the sense of composure all the time. At first, I was pretty intimidated by him since he remained so taciturn most of the time. But later I came to realize he could be a good chatter as well!
l Department of Pathology
This department is run by Dr. Alex who’s the only non-Taiwanese on the team. One time, we were invited over to the Department of Pathology to have a look at his daily duty. There were some old medical machines there, and trust me on this, you don’t get those in Taiwan anymore. But still, Dr. Alex reminded us to be very flexible working in Malawi. Those machines are acting up all the time, but he always came up with a way to resolve them, such as redirecting the routes to get his samples done.
Dr. Alex inspired me a great deal with his sense of humor as well as the perseverance he had while carrying out his duty.
l TBA (Traditional Birth Attendant)
TBA is also a very interesting system to me. Since the medical service is not widely provided in Malawi, some of the villagers may not get instant help in their vicinity. Therefore there emerged a useful system like this. The duty of a TBA is similar to that of a midwife. Around 25 midwives were recruited per intake and were trained to be a more professional TBA. Ms. Janny was the leader setting up this program and making things run. She had some statistics done and those figures actually revealed that the TBAs had enormously reduced the mortality rates of the newborn infants which went on to show this TBA program could really make a difference!
This is a typical delivery room for the TBAs in Malawi. Not well equipped at all but it still comes into use.
l Maintenance
All the credits go out to Mr. Ryan and Mr. Conga. They’re really busy at all times. If anything cropped up in the hospital or in the missionary team, they were definitely the people to be summoned for the “first-aid help”! But I think the people there relied on Ryan too much that he could barely catch a breath!
Ryan, Claire and me at their home sweet home.
A story or two to tell…
A hard bargain
I didn’t like buying things in Malawi. A lot of times we went to the town in hopes of purchasing stuffs or souvenirs at dirt cheap prices. This was a normal phenomenon everywhere: People tried out every means to get a hold of things without shelling out big bucks.
I had some experiences in which I felt extremely sad about the way people traded here. Lot and lots of foreigners came to Malawi every day. Most of them were members from various International Aid Programs. As a result, the business flourished because of these big customers. Many stands selling wooden sculptures and art paintings were set up by the locals to rake in money from the foreigners.
Day after day, I saw a lot of the buyers putting up a hard bargain when trading with the locals. Everybody wanted to gain the most and give the least. I had to say Malawians are extremely poor on average. A little money that we successfully squeezed from them might not mean a thing to us; but it could mean the world to them.
“Hello, my friend. I can give you good prices. Just name a price, alright?” this was what I normally heard when browsing through the selections of the art pieces.
Gradually I came to realize that I was frequently caught up in the dilemma of whether or not to buy things from them. For one thing, I was not abundant financially, that’s why I couldn’t tip them. Another point being, if I went easy on their original prices without comparison shopping, chances were, I would ruin the balance as well as the market rate in that particular place. Also, a big variety of rip-offs could spring up undoubtedly.
Out of no choice, I decided to step back from all sorts of trading. I understand that in so doing I could not contribute a bit to this country financially, but I’m still better off not driving a hard bargain with them.
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Dilemma
“Look at this patient, Eddy. This is a very typical case of Burkitt’s Lymphoma.” Dr. Bong directed me to a ten-year-old boy during his routine pediatrics ward rotation. “You don’t get to see a case like this very often back in Taiwan. He’s suffering a great deal and can at most hang through another two weeks only.
I nodded silently, not knowing what to say.
The boy’s father was standing by the bedside, totally clueless. He wasn’t able to converse in English, therefore Dr. Bong had a Malawian nurse translated the diagnostic information for him.
A moment later, in there came an internist, Dr. Ron. He and Dr. Bong had a little discussion on the boy’s condition as well as the regimen. With an ultra sonogram being dragged to next to the boy, Dr. Ron performed an examination on him. His pancreas was okay, however, his lung got a little fluid-filled. Also, he pointed out that the boy was suffering from ascites.
The boy was so weak that he could barely move. The attending nurse told us she had fed him some congee in the morning, hoping to keep his stomach okay. Looking at him, I knew I could do nothing but to pray for him fervently.
It was always the hardest time when it came to informing the family that the patient might not get to hang in there anymore. Dr. Ron turned around to the father, solemnly, he asked him whether or not to carry on the medication because the kid was responding poorly to the drugs. And that he could only live for another two weeks at most. The Gate of Death was wide open ahead. Furthermore, the super heavy dose of medication was just like any poisons which definitely would bring more sufferings to the boy.
The clock was ticking and the nurse was busy translating the explanation into the native language, Tumbuka.
Holding his breath, the father thought for a moment. It seemed like everything was stationary, and I was waiting for him to respond. Eventually he said in Tumbuka, “Can I take my boy home?”
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The Need
Are we here to help or to hurt? I’m clueless.
I had this thought all over my mind on the day when Isaac, one of my colleagues from the medical record room, asked me to sell my cell phone to him at a cheap price.
“What do you need a cell phone for?” Taken aback by his request, I hoped I could know the reason.
“My friends all have a mobile, so I think it’s time I got one.” He had a smile on his face. He continued, “We Malawians are very poor. We are working very hard, but we’re lacking resources. You people are a lot richer, please sell your phone to me. You can always replace it after you get back to Taiwan.”
I was somewhat wordless for a while. My Malawian friend, Isaac, didn’t really need a mobile. Mobile phones were not a necessity I Malawi. For one thing, there was no an extensive network. Furthermore, generally speaking, the expenditure on a cell phone was still a very massive burden to them.
Nonetheless, I could empathize with him in a way. Human beings bore desires and we all harbored dreams every now and then. It was understandable that Isaac wanted a mobile so badly to be part of his properties since a great number of international voluntary workers had brought this thing into this country. What really got me thinking was that Isaac never knew the reason why he was so desperate to have a personal phone.
This was just a minor evidence of the assimilation of the foreign values and mindsets into Malawian hearts. I couldn’t help but wonder: Are we really do |
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