Malawi

So, right now I am in Malawi at the Malamulo Mission Hospital. Last Tuesday at 4 AM the LIFE students and myself started off our morning by pushing the truck at Riverside until the driver could get it started. Then we hopped in the back and we were off! We reached the bus station around 5:30, just in time to buy our tickets, store our luggage, say our goodbye’s to those who were not coming with, and head out. When we bought our tickets we were told that the bus went all the way to Lilongwe, Malawi. So, we were planning to go straight there and then bus down to Blantyre from there. So, imagine our surprise when we found ourselves getting off the bus several miles from the border. Turns out we were misinformed. So, we took a taxi to the border, went through immigration on the Zambia side (basically getting an exit stamp on our passports), then we took a taxi to the other side of the border and got an entry visa there.
Now, the man on the Malawi side of the border was quite friendly, gave me his phone number and everything. (He’s planning on me taking him with me to see Riverside Farms… silly). So, I had a little chat with him trying to figure some things out. We wanted to exchange some money for Malawi kwacha (thought the taxi driver would probably be expecting some money at the end of the trip), but didn’t want to exchange on the black market. So, we were asking if there was somewhere we could exchange money. The immigration officer said no, there isn’t anywhere until you get to Lilongwe, you’ll have to trade on the black market. So I got info from him telling me what kind of exchange rate would be good, how much it would cost to get to Blantyre, etc. Now, at the border and several of the bus stations, as soon as you open the car door you are surrounded by men shoving money in your face trying to get you to change your money with them. So, it wasn’t hard to find them. They all carry calculators around in their hands, so when I asked them what kind of rate they would give me and told them how much I was exchanging, they started calculating. I asked the man I was dealing with to let me see the calculator so I could add it up, I took it from his hands and started punching numbers in only to find it was dead. Finally someone produced a working calculator, so we used that to figure how much they owed us. Sneaky sneaky people.
Wednesday was a rather easy day. Not a whole lot going on. Got a brief tour of the hospital, met the director, things like that. Then Thursday I spent the day with Dr. Fam, the surgeon. He let me come on rounds with him. We visited a man who had had a couple toes amputated, a lady who had all of hers amputated, men recovering from prostate surgery, a man who would have his prostate out later that day, a girl ready for her skin graft, etc… Then he let me come watch him perform surgery, and not only that, but he let me scrub in.
The first surgery was the removal of a man’s prostate. Its great, before each surgery Dr. Fam sits and has his own quiet prayer time, then there is a group prayer, then the surgery begins. I like how they work. I got to help with retraction and suctioning. The surgery probably took about 4 hours in all. As soon as that surgery was over, it was time to take care of an emergency. A boy had been cutting sugar cane, swung the blade, missed the knife, but nearly amputated his thumb. It had a huge gash in it, fractured bone, and the thumb was dangling. So, Dr. Fam cauterized the blood vessels, then stitched the ligaments and a tendon back together. So far it seems to be doing fine. They were worried the blood supply would be lost and they wouldn’t be able to save it. After that, it was a lady who had had an incomplete abortion. The baby was out but the placenta and umbilical cord were still inside. So, an intern took this long metal thing and scraped the rest out and into a trash can.
Next was a skin graft on a little girl’s foot. Hot porridge had spilled and burned her foot. It was interesting. They removed skin from her upper thigh to use for the graft. To remove the skin, they used this thing that kind of reminded me of the side of the cheese grater that you use for slicing the cheese, only it had a motor. My job was to grab the skin with tweezers as it came through. They then put slits in the skin, stretched it, then put it in place with Vaseline gauze over it, after removing all the tissue that had grown since the burn happened. Finally, there was a lady with peritonitis. Her whole abdominal cavity was infected, filled with pus. As soon as the Doctor got into the cavity I had to start suctioning, and if he moved his finger the slightest bit, pus went spurting everywhere, like a drinking fountain that has just been turned on. And it smelled beautiful! It turns out the appendix had ruptured, causing the infection. So, he removed the appendix, cleaned her insides up with saline and iodine, then closed her up.
Friday I went on rounds with Dr. Fam again. It was just a quick trip around the hospital as it was preparation day and they try not to do any more work than they have to on Friday. There was a little baby boy with a herniated belly button. Dr. Fam pushed the hernia in with his finger. As soon as the baby started crying the hernia popped back out. So Dr. Fam had me push it in. It was fun to play with. Push it in, baby cries, it pops out, push it in again. I think Dr. Fam operated on him Sunday morning.
Saturday we went to church, of course. It was nice. The children had the program which means lots of special musical numbers. After church was potluck, then we went for a walk through the tea plantation. By the way, Malawi is beautiful! I need to get out and take more pictures.
Sunday I went on rounds with Dr. Christie. She is a family practitioner. Since the hospital here is a teaching hospital, she had a herd of students with her as she made her rounds. It was interesting, not quite as fascinating as surgery though. She did an ultra sound on one of her patients to see why she was having such severe abdominal pain (she wasn’t pregnant). In the ultra sound it looked like there was fluid around the uterus, and maybe an abscess in there somewhere. Every time you touched this woman’s belly she started crying, and I mean really crying. So, the only way to tell what was really going on was to perform surgery since they don’t have a lot of fancy advanced medical equipment here.
I got to scrub in for the surgery and assist. I was able to help more this time because there weren’t as many people in the Theater as there had been before. They weren’t especially happy to be opening her up because she is HIV positive and when you get opened up your immune system is affected, so they wanted to do this as fast as possible. Dr. Fam opened her up, I helped hold her skin so he could use the scissors, soak up blood, things like that. When he got into the cavity there, we were met with all the fluid that showed up on ultra sound. So, we soaked that up. Then you could see the culprit. Tiny little tumors coated her intestines, the lining of her abdominal cavity, we stuck our hands up and felt around the liver and there were tumors all over that too, same for the uterus, bladder, you name it. Dr. Fam just shook his head and said, “Only Jesus can saver her now.” Sad thing is, in opening her up, we decreased the amount of time she has left. After that, he started stitching the inner layers of her skin back together, then he left the rest of us to close up the outer layer of skin. So, I’m thinking I’ll be assisting the man to my left as he stitches her back together, but no, as Dr. Fam left he said Chaalie, teach Megan how to suture. So, I stitched her back together. Kinda freaky, especially when they told me she was starting to wake up. Yikes! I felt really clumsy because when you suture you don’t just use needle, thread, and fingers. You have to hold the needle with this special needle holder, and use another tool to pull the skin tight as you stitch. Twas interesting.
After that surgery, the man with the amputated toes came in, he has diabetes and the feet problems are the result of ulcers. He had some pus down in there somewhere, so Dr. Fam was trying to find the culprit. It was a simple, yet time consuming surgery as his foot kept bleeding and we had to keep waiting for it to stop bleeding to continue. Hopefully he got everything. To end with, he poured honey into all of the holes in the mans foot. He says that the sugar concentration in honey doesn’t allow for bacterial growth, or something like that. Quite interesting.
Anywho… I think this blog has gone long enough… more to come.