what you could be listening to

In preparation for my homecoming (and because I was badgered to post), below are a few popular songs played here that I will be forcing all of you to listen to when I'm States-side next week. These songs are multi-purpose playing everywhere from wedding and engagement ceremonies to the clubs. It's interesting to note that none of the artists are Malawian... they are all Nigerian and sometimes South African or Sean Paul or Wiz Khalifa or Enrique. (I haven't actually been able to watch these particular videos due to bandwidth issues, so I hope they are the right ones and not totally inappropriate. Apologizing in advance). 

Naeto C - 10 over 10

(One of my favorite songs. I actually saw this guy "play" aka lipsync at a local club, Zanzi Bar. What was supposed to be an awesome night ended with my US phone being stolen along with my Angry Birds account). 

Ice Prince - Oleku 
(you should also check out Superstar)

DJ Flavour - Ashawo 

(otherwise known as 'the sawa sawa song' or 'that song they always play at weddings')

Happy World AIDS Day

Happy World AIDS Day! 

With global economic crises, funding for HIV and other health-related programs has been frozen. I have been in Malawi now for almost 5 months where the implications of HIV are incredibly apparent, at least compared to the States. It is painfully clear how important this funding is to keep HIV at bay, prevent new infections, reduce poverty, improve quality of life - anything, you name it. Funding really should be increased - with ART, many people are living longer (and are otherwise healthy!), particularly children. This is great! But it also means that medications and treatment need to continue to be available and needs to be more accessible otherwise the virus will come roaring back on individual and population levels. Additionally, despite very effective PMTCT options, mother-to-child transmission still occurs. Many of the exposed infants we saw in the last study I worked on either did not receive PMTCT or their moms didn't for whatever reasons. Access to PMTCT needs to improve - many moms don't go to hospitals to give birth or can't make it, don't know their status, are newly infected, etc and so there is a much higher risk of vertically passing HIV to their babies. Malawi recently implemented Option B+ - HIV-infected pregnant or breastfeeding women will be initiated on drugs and on them for life - which theoretically should drastically reduce vertical transmission rates (ART -> less virus -> less chance infant will become infected). This, however, requires money. I realize the effects of aid and donor money can be debated endlessly and that all (or almost all) governments and people are tight on cash, but I believe this is a matter of human rights and dignity. HIV might not be curable right now, but it certainly can be managed. The tools exist, but they need to be more available and accessible.

Here are some facts about HIV in Malawi:

• About 12% of the population is infected with HIV - that is around 930,000 people 
• An estimated 84,000 new infections occur annually
• ~35% of HIV-infected people are on ART
• Only 55% of those who need ART receive it
• 63% of new adult TB patients have HIV
• 91,000 kids are HIV-+ (as of 2007) 
• More than 500,000 children have been orphaned by AIDS

(http://www.usaid.gov/our_work/global_health/aids/Countries/africa/malawi_profile.pdf)

Thanksgiving in Malawi

Last night we celebrated Thanksgiving. We didn't have the actual day off so we put off the cooking until the weekend. Probably a good thing since about 40 something people showed up. I said I would make mashed sweet potatoes, one of my favorite tgiving dishes. Unfortunately sweet potatoes recently went out of season. I heard that they might be at the central market so we went to check it out. After scouring the market, I took a chance and bought some yams that people said were sweet. They weren't. They were African yams (not the sweet potato kind, just like regular potatoes). I attempted to mash them and though they were good, they looked really weird.

Sonali setting up the buffet

Since I said that Thanksgiving is my all time favorite holiday, I somehow ended up responsible for cooking the turkey (frozen and from North Carolina!). With some instruction and help from friends, the turkey came out pretty good!! That in addition to the mashed potatoes, stuffing, cranberry sauce ($10/can!?), casseroles, veggies, rolls, pecan pie, pumpkin pie, apple pie, wine, mojitos, and good company made for a fantastic Thanksgiving celebration.

the turkey i made! a little singed on top but was really good

now on to the next thing

Today I officially finished my work on the early infant HIV diagnosis study, otherwise known as the PDHIV study. After 4 months of database tinkering, data entry, data supervision, and data merging/cleaning (aka way too much data), I am excited to take a breather from looking at numbers and Microsoft access. Although I know for sure that data management is not what I am looking to do in my future career, I guess you have to start somewhere and I have definitely learned a lot from the process. For example, a well-structured and functioning database is crucial for easy but accurate entry and therefore solid data sets and good analysis. This somewhat boring data stuff, however, was not all that I was doing (thank god). I also got loads of clinical experience - I can do induced sputums, gastric aspirates, set up and change IVs (not put them in), order labs, take sats among other measurements, and be mistaken for a doctor by people in the hospital including expats (I find this incredibly entertaining). I (re)learned that I liked being in the hospital (I guess taking the MCAT wasn't for nothing), and that working in resource-limited settings and in broken systems can be frustrating for everyone - patients, guardians, nurses, clinicians, Malawian or not - yet incredibly rewarding.

tuckaways

view from the chalet

To celebrate the culmination of the past 4 months of this work, I went to Cape Maclear for the weekend with some friends who work at Baylor (the peds HIV clinic). After spending several hours there a couple weekends ago, I was itching to get back but for longer. Friday night, I hung out at Leah and Jared's house (2 of the friends) eating Indian food, playing Mario Kart, and watching Freaks and Geeks (I fell asleep 1.5 episodes in at about 9 with their cat sleeping on top of me). We woke up bright and early Saturday morning, literally at the crack of dawn, picked up the other friend Ally, and arrived at our lodging mid-morning. We stayed at this place called Tuckaways, a group of 5 reed chalets right on the beach with shared bathrooms/showers. It's beautiful, clean, and totally affordable at a whopping $32/person/night. AND you could pay with a Visa! A weird thing when living in a cash-based economy. The day we got there, Saturday, we just chilled on the beach, went swimming, dove off moored rowboats, and generally enjoyed escaping from Lilongwe, the heat, and the petrol shortage. The resorts at Cape Maclear are situated right in the town/village along the coast so there are plenty of cute (obviously targeted at the tourists) restaurants, bars, and socially places to go with great food and drinks beyond the [insert alcohol+soda] combos, beer and wine. Plus, they had tonic.

yum! fish!

On Sunday we woke up early for breakfast. I had a veggie omelette with CHEESE! cheese is an expensive commodity. We then hired a boat to take us out to Thumbi island. When we arrived, we immediately jumped in and went snorkeling with the cichlids (those colorful, aquarium fish). You could get them to swarm and eat out of your hands by throwing/holding pieces of bread, providing endless entertainment. While we were swimming around, our boat guy, Harry, was making us lunch. He cooked us up some fresh lake fish, rice, and tomato/potato sauce. After eating, we hung out on the rocks for a couple hours and I finally got in some solid reading time. We then headed back to the shore, had some drinks and dinner, and later went night swimming. It was nice to enjoy the water without fear of rip tides, sharks, crabs, or sepsis like I do in the Atlantic and Chesapeake Bay. At 3:45 Monday morning, we woke up, packed up, and headed back to LLW just in time for work. I'm still recovering from that early morning and my sunburn that I got despite multiple applications of sunscreen. Parents, you should be proud - for some reason I really want to go sailing. I haven't found a boat to rent out yet, but it's going to happen at some point.

kids fishing with mosquito nets. guess things i learned in class do happen

Now, I'm back in Lilongwe in between projects and refreshed. I've been working on my PMTCT secondary analysis and figuring out Stata, which I had put off for a solid 2 months. I crunched some numbers and now need to figure out the statistical tests and find some GIS data. As for the next project(s)? I will be a study coordinator for a reproductive health study at Lighthouse (the adult HIV clinic) that is looking at sexual behavior, practices and beliefs of HIV+ men and women and will compare those who are on vs off ART. I'm excited to put my culanth major to work and to have a little more responsibility on a project, though reticent to be waking up a full hour earlier for morning meetings. I'm not sure when this study will be starting, which is why I may also do some more clinical stuff on two pediatric studies (run by my housemates): one looking at TB prevalence among inpatient malnourished kids using a geneXpert (a machine, not a person), and the other looking at cardiac function of HIV+ children with a fancy echo machine and 6-minute walk tests.

For now, I'm just really really excited for my all time favorite holiday - Thanksgiving. Although I'm bummed I won't be home (just 5 more weeks?!), I suppose skype will suffice, and my attempts at cooking and finding necessary items should be pretty funny.

despite its issues, gotta love malawi

The current state of Malawi

Below is an article that briefly describes what is going on in this place right now.  In short: no aid money and poor exports means no dollars which leads to no fuel, failing businesses, increasing prices, power outages, water shut offs, and most importantly, no tonic or minerals. Malawi is on the verge of paralysis (UNC transports fuel supply apparently dried up!). The fuel shortage doesn't just affect those with cars - it affects public transportation and transport of goods (no more tomatoes at the market?), for example. There are a variety of ways to get fuel: 1) Wait for hours at the petrol station (imagine sitting in the heat of the day for 6 hours to be told the fuel dried up). 2) pay someone to take your car or jerrycan and wait in line (however, it takes gas to find gas). 3) Forget the hassle and buy fuel on the black market sold at twice the price and you don't know what's in it.  Gas is already expensive at the pump (290MK/L = $7/gallon) so on the black market it is about $14/gallon!! And yes, the black market is actually a place - its a bunch of guys sketchily standing in the Game parking lot (they pay off the police) and they give a much better rate for the kwacha (220/$ vs 165/$, thats 5,500 more kwacha per $100).

Many of my friends have had their water shut off for 1 or more days at a time and no power. With it being the hot season, that's not good. It's still in the 80s-ish at night - without a fan it's difficult to sleep. I've started sleeping with a wet chitenje (cloth) draped over me to keep cool. I've also gained an appreciation for why people hate to use mosquito nets - its like sleeping in a un-airconditioned attic crawl space with no air circulation - I swear it increases the temperature by about 10 degrees.

The situation is probably not going to improve for another month+ since the president went on vacation to Australia (on Malawi's dime, according to the Nyasa times he requested or got $500,000?!). This isn't very promising for getting countries and banks to give aid money, which comprises about or more than 50% of the annual budget. I wouldn't be surprised if more demonstrations occurred.

Well, thank god my friend found some petrol... off to the lake this weekend it is! Hopefully we find gas to get back... or not, I wouldn't mind being stuck in Mangochi.

World Bank tells Malawi: Address concerns to get aid

The aid freeze started earlier this year with a diplomatic spat with Britain, Malawi’s biggest donor, caused by a leaked diplomatic cable that labelled Mutharika “autocratic and intolerant of criticism”.

Washington joined in after the July violence, suspending a $350m project to upgrade the impoverished, land-locked state’s decrepit electricity grid.

Combined with a collapse in revenues from tobacco, Malawi’s main foreign exchange earner, the aid embargo has triggered an acute dollar shortage, putting pressure on the kwacha currency and hitting imports of basics such as food and fuel.

Petrol stations are frequently dry, and when they do have fuel, motorists are forced to queue for hours to fill up.

The hardship in evidence on the streets is in stark contrast to the official statistics, which suggest which suggest that Malawi has been among the world’s fastest-growing economies in the last six years.

Much of that performance has been based on a fertiliser subsidy scheme for farmers, although the aid freeze has also thrown that programme into doubt.

it is officially the hot season

Daily temps in the 90s, super strong sun, and 0% chance of rain...

Mangochi & Cape Maclear

Cape Maclear

Mangochi

Another amazing lake weekend! For the past 3 months, I have been working on a study database and entering 300 files of data. I finally finished last week and started supervising the second entry process. I was really ready for a nice break, so after sending another friend off back to the US and a Zanzi night on Friday, I headed to the lake with one of my friends. Her friend has a lake house in Mangochi so we attempted to leave bright and early Saturday (aka 11am) to make it for the weekend. For some odd reason I woke up at 6am, probably due to the bright and very hot early morning sun, so I caught up on some tv shows. We spent the day hanging out at the house and waiting for lunch, which we ended up eating at like 4 (and dinner at about 12am), and swimming in the lake.

Cichlids

On Sunday, we headed off to Cape Maclear, a beach in a national park, about 30-40 minutes away. This place is absolutely amazing and since its protected, totally pristine. There are a bunch of lodges amidst the town/village right along the water's edge, so there seems to be a lot to do and very vibrant. Upon arrival, we organized a boat to go snorkeling and grabbed some drinks while we waited. We then headed out to an island off the coast and snorkeled to check out the cichlids. Cichlids are protected fish in these waters. They are really cool looking - they are tiny striped fish (sort of like aquarium fish-sized) but come in a variety of bright colors ranging from black, brown to blue, purple, and yellow. After snorkeling, we saw some big fish-eagles feed, then headed back to shore to chill on the beach for a bit. Finally, we went back to Mangochi for a dinner of chambo, a white fish (tilapia) found in the Lake, guacamole, casserole, and brownies.

sunset on saturday

Today (Monday), we ate breakfast and enjoyed the beach for a couple more hours before heading back to LLW. Overall a fantastic weekend, cant wait to get back. Perhaps I will even be tan come December...

malaria no more?

UNC Project was one of the sites for this trial (MAVAC)!

Experimental malaria vaccine protects many children, study shows

fuel crisis?

Line for the Petroda, it goes around the block

For the past 2 weeks or so there has been little to no fuel - diesel or petrol - in the entire city maybe even the whole country. In July, this was supposedly due to the lack of foreign currency so the government couldn't purchase fuel. This time, Malawi was hosting some international conference. The government decided that it would be embarrassing for there to be queues for fuel, so they didn't let any fuel trucks deliver to the stations in Lilongwe. This meant that much of the city had to shut down - people couldn't get to work since the minibuses weren't able to function, transport prices skyrocketed, there was no tonic left in the city. Today, once the foreign Heads of States left, the trucks delivered fuel to the stations. Every gas station had a ridiculous line of cars going down the street and crowds of people with jerricans hoping for fuel. Complete mayhem. It is also very frustrating to not be able to leave the city and have a break when you can't be sure you can get back or even get out of town.

The Crossroads station is ambushed by thirsty vehicles

Senga Bay

I just got back from an amazing weekend to Senga Bay on the beautiful Lake Malawi with 2 friends - Laura and Alex. It was a 3 day weekend for Mother's Day. We were planning on going Saturday but the fuel situation is bad again and we didn't want to stay for the music festival that was happening there (a mini Lake of Stars). This was a little stressful so instead we chilled by a pool and went out to dinner. The next morning we woke up early, caught a ride to Steps (the campsite) from a friend, set up our tent, then headed next door to the Sunbird hotel for lunch and a relaxing beach day. That night we met up with 2 other friends and chilled on the beach listening to music. This morning we woke up bright and early yet again (mostly because the sun came up at like 5 and people started blaring music at 5:30, not appreciated). We caught a bus to Salima then a minibus back to Lilongwe. I have heard horror stories about minibus rides outside of the city so I was very apprehensive about it, but it was fine. I guess we had a good driver. On the way back, we took off on a side dirt road, turns out the driver was buying black market fuel. We finally got back to Lilongwe, went to the market, then home. All in all a great weekend!! To think Senga is the "convenient" lake spot and not close to the best...

A view of Lizard Island at Senga Bay

Lake of Stars

Last weekend my friends and I went to the event of the year - Lake of Stars. LOS is an international music festival started by some guy in the UK to raise awareness of Malawian culture and improve tourism. The festival originally rotated locations around Lake Malawi, but now occurs annually in Mangochi (Nkopola to be exact) on the beach. There were 3 stages, all along the water's edge. It was a beautiful location, though incredibly hot during the day. Thankfully the group I went with chose to stay at a hotel rather than camp (I appreciate air conditioning...). There were bands from all over - South Africa, Malawi, and the UK. Some of note were Freshlyground and Malawi's own Lucius Banda. I would recommend checking out Freshlyground - great band from SA, featured in that Waka Waka song from the World Cup. My housemate Sonali's band, Thatch Roof Carousel, played as well. They were great! LOS definitely lived up to the hype and was loads of fun, I think I saw almost everyone I know there. Here are some pics!

Thatch Roof Carousel

Lucius!

A view of the lake and festival site

Challenges for admitted patients

In my time here, we have had a fair number of enrolled babies die. Or at least it seems like a lot to me, granted this is a skewed population - sick and admitted to the hospital as well as HIV exposed (if the mothers are sick, the babies will probably be sick too). Here are some challenges I have noticed thus far for admitted pediatric patients, their families, and the clinicians trying to practice medicine and get them well:

1)    There are constant drug and supply shortages at the hospital, including basic medicines, so patients can’t receive necessary treatment

2)    A lot of times kids won’t be given proper dosages of medicines or prescribed medicines at all. There could be a lot of reasons for this: nurses are overworked, there are a lot of patients and many to a single bed making it difficult to see all patients or have a highly functional system, caregivers and the patients are outside and not in the ward at time of drug dispensing, lack of health literacy among parents so they don’t understand what, when or how much of the meds their children should receive, etc

3)    The hospital is dirty so kids will oftentimes come down with hospital-borne illnesses that could drastically delay their recovery or kill them

4)    The guardian must stay (basically live) with the admitted child in the ward, which is not the most pleasant place. This means that someone must bring them food, guardians (the vast majority are women) must leave their other children and responsibilities at home. It’s a huge hardship on the family so many patients abscond.

5)    Misdiagnosis

I thought it was supposed to be the beginning of the dry/hot season...

nope, instead it RAINED. no complaints here! minus the fact the power went out and i couldnt cook dinner.

Blantyre & Mulanje

View of Blantyre from the hotel

This weekend I went to Blantyre and Mt. Mulanje with Amy. Amy used to work in Blantyre and is helping out at a pediatric cardiology clinic down there so I decided to tag along. We left on Saturday and after a 4.5 hour drive without getting stopped by police officers (!), we arrived in Blantyre. We stayed at a lodge and were supposed to each have our own room with shared bath, but they lost our reservation so we ended up sharing a much nicer room with a private bath for the same price. 

At Likhubula falls

Mulanje and the tea estates

That night we did a sort of pub crawl. Blantyre is a lot more like a city than Lilongwe and has a bunch of chill bars to hang out at. Amazingly, at one of said bars I met a recent Duke grad!! And I thought I was the only one… The next day Amy, her friend Tinu, and I ventured out to Mt. Mulanje. Mulanje is a mountain about an hour outside the city and either already is or will be an UNESCO World Heritage Site. The drive there cuts through tea plantations and is beautiful. After grabbing a quick pizza, we decided to do the quick 45 minute walk/hike to the Likhubula waterfall. Once we got there, we spent the next 2 hours swimming in the (freezing) pools, jumping off of rocks, and taking in the scenery. Definitely an awesome day and I really want to go back to hike Mulanje plateau and the peaks. Monday and Tuesday I went with Amy to cardiology clinic at Queen Elizabeth Central Hospital (the main hospital in Blantyre). On Tuesday we saw and echo-d over 20 kids. Amy says I won’t know what a normal heart looks or sounds like by the time I get home since nearly all the kids she sees have some sort of pathology. We then made the drive back to Lilongwe and celebrated our housemate Sylvia’s birthday with home-cooked Indian food! 

Mulanje

Today, Wednesday (9/21), there are supposedly more protests so it looks like I will be spending the day entering data. Almost 100 down!! 

From the Ward B treatment room

almost empty shelves

lots of stuff in case of emergency

treatment bed

Here are some pics we took from the Ward B (peds) treatment room - this is where we do all study tests including blood draws (for HIV tests, cultures, labs, etc), lumbar punctures, and induced sputums to test for TB and PCP. I have learned how to, under supervision, induce sputum as well as how to do gastric aspirates in babies - unlike adults they can't produce their own sputum (luckily this also means they can't actively spread TB). For an induced sputum, we give them some medicines from an inhaler to loosen the stuff up, then some hypertonic saline through a mask to draw the sputum out of the airway linings (uses osmosis, I guess gen chem is applicable), then we suck it up through a tube that we stick down the nose and into the throat. Finally, we send it to the lab and wait to see if the child has TB and/or PCP. 

The study aide loosening up some sputum

me about to insert the tube. Notice the N95 mask, I will NOT be getting a positive ppd next year.

suckin out that sputum

Well, this has been a bad day

After seeing several other very sick children, today, I saw a baby die for the first time. Eric had told me about some of the babies in the study that passed, usually on the weekends, but I had never actually seen one. This baby was born a couple hours before, sometime over the night. He was not enrolled in the study – the mother had been on ART for a long time – but we saw him anyways. The study assistant told Eric about the baby and about 30 minutes later we went to see him. The baby looked very sick and pale, white almost. Eric turned the baby over and it was not breathing, spit-up drooled out of his mouth. It didn’t look good though Eric could hear faint heartbeats. Eric started bagging the baby to resuscitate it and loads and loads of formula vomit came spilling out. Him and two nurses started chest compressions and bagging in an attempt to get him to breath on his on. They then tried putting oxygen back on. The baby died. The agogo (grandmother) was watching and we told her what had happened. The agogo got the father and then the nurse told him. It was hard watching this infant die in front of me, but it was a million times more difficult to see the father as he was told the news. I cannot imagine telling the mother, I’m sure it would be even more difficult. Apparently this happens all the time, usually due to a lack of monitoring or something, though this was not the case with this baby. Eric said he would often be called to see a patient and the patient would be dead when he got there and no one knew.  

A lesson on bribes

Sylvia and I were driving (well, I was the driver) to ABC, where the UNC soccer team plays, when we were flagged down by a police officer. It wasn’t like we did anything wrong, they were stopping everybody. I was a little concerned because we had just dropped Sonali off at the bus stop and we were running a little late for the 8:30am game, which turns out was postponed to 10 unannounced to us. So we pulled over, thinking it would be a 5-minute process, when the police officer takes my license and informs us that all of our insurance stickers had expired last week. I checked the stickers and he was telling the truth. This is not something we as trainees are responsible for since it’s a UNC car, and I had recently been told a story where someone almost went to jail for expired insurance so I was worried. Plus I was the driver so I would be the one rotting in a cell. I called my boss and after about 15 minutes of back-and-forth I was instructed to pay him no more than MK3000 and that UNC would not let me go to jail, very reassuring. I've seen people bribe before but I've never been the one handing over the cash. I'm a little torn on the issues of bribes - on the one hand it fuels corruption but on the other hand this guy needs to feed his family and probably hasn't gotten paid in months. Kind of like a waitressing job where you get paid nothing but get topped off on tips... not that I've waitressed before either.

So anyways, I talk to the guy and he says that the fine is MK20,000 – 10,000 for the expired insurance and 5,000 for each person in the car. WOW, that’s a little over $60. We told him we only had 3,000, which was dumb, we should have said lower but I just wanted to get out of there, I hate bargaining. He said it was okay and that we were “helping each other out,” but that he wouldn’t be able to get a cash receipt since we didn’t pay the actual fine. Darn it, I really wanted to get reimbursed from the project for this expenditure. He then instructed me on how to properly hand him the money with the 100s out and folded lots of times. I found this funny, I've never been involved in shady money transfers. Finally, we were on our way. Unfortunately we didn’t go to the game – no one would pick us up from the guesthouse – but on the bright side I didn’t go to jail.  

GUTS!

yes, i do look pretty ridiculous

This past Wednesday, I saw some surgeries for the first time. I borrowed a pair of scrubs from one of my housemates, unfortunately they were the wrong color blue but I think I need to get over the rivalry at this point. You also have to wear rubber boots into the OR. Two UNC surgeons came for the week so I was able to see some procedures up close. I was able to stand in on 3 surgeries, all pediatric. I saw two colostomy take downs where they cut out a section of the bowel and then sew the 2 pieces together. Lots of GUTS! I also saw a procedure on a kid probably about 5 years old who had a trach in because papilloma scarring in his trachea caused the airway to close off. He was really scared before they gave him drugs, it was pretty sad I felt really bad for him. The surgeon attempted to clear out the scar tissue but by the time she got in, it had already sealed off so the poor kid will probably have a tube sticking out of his neck for the rest of his life. Although I didn’t scrub in on any of the surgeries, I did get a really good view (and didn’t feel nauseous at all!) and made myself useful by fetching sutures and such.

The ORs at KCH are pretty pitiful though I haven’t seen one in the US… Surgery seems pretty cool but I think it would be better to see one when I actually know what the anatomy is and can understand why they are doing what they do. 

Hiking Dedza

I finally got out of Lilongwe! I went with 3 of my housemates, Sonali, Bryce, and Melike (all just finished 3^rd year of med school), to Dedza for a day hike. The day began with us miraculously finding petrol without even waiting – we saw a car filling up just outside of LLW, we pulled up behind them and 5 minutes later we had a full tank. In a fuel crisis, this was awesome and clearly a sign of a good day. We then continued on our journey and parked at the base of Dedza mountain.

Me at the peak

I assumed we were taking a leisurely hike up a not-so-high mountain (more like a rocky hill), which turned out to be false. Perhaps that’s because we started on the wrong trail after being led to some random path. Said path was pretty much at almost a 90º angle, which was hard on my knees and on my lungs. It may be the altitude or diesel fumes, but I think my childhood “sports induced asthma” might be coming back (aka I’m out of shape). Meanwhile, there were these women carrying probably over 50lbs of sticks, no, logs, on their heads down the narrow snakey paths. This made me feel even better about myself, I maintain its asthma…

view from the top. sometimes you can see lake malawi

everything is burned!

We finally made it up to the top where there were several signal antennas then realized that we still had 3km until the peak. We continued on, scaled a rock face, and finally reached the top. Although the dust and smoke from people burning nearly everything clouded the views, it was still stunning. After eating a power bar, thanks to Melike, we started to make our way back. We decided that we definitely did not want to slide on our butts down the initial path we took, so we looked for the “road,” or wider path with some overgrown grass, that appeared to switch back and forth up the mountain. When we reached this road, we followed it for a bit then decided that we had no idea where we were going so we cut down the mountain on what we thought was a trail. False. We ended up sliding and bushwacking down the mountain until we reached the really steep path we took up and vowed to avoid. Poor Bryce was doing this with a sprained ankle. We took that for a little then when we hit the second road, Sonali found a less steep path that we took down to where we parked our car. Turns out this nice path was the one we should’ve taken in the first place. Whoops!

dedza pottery

After reaching the bottom, we drove to Dedza Pottery (an overpriced store that sells and makes famous Malawian pottery, obviously). The shop has a lodge and a restaurant. We stopped to eat lunch at like 3pm. I had a fanta passion, quiche, cheesecake and tea. All delicious especially considering all I had to eat was that power bar, cereal and a nalgene of water. Then, we went home.

Although I am wiped now, it was a great day and really really nice to get out of Lilongwe. I was able to display my awful sense of direction to my new housemates, which perhaps contributed to our adventures down various wrong paths (while I adamantly maintained that I knew exaaaactly where we were going). 

mmmm cheesecake. nom nom nom

my favorite food

tomatoes are sold by the stack ("bundle")

Yes, tomatoes are among my top 5 favorites foods if not #1. I’ll eat them with anything or even plain; whenever my parents brought back cherry tomatoes from the grocery store they were gone within 30 minutes. Nothing makes me happier than a perfectly ripe tomato. So I was pleasantly surprised when I discovered that Malawi has some AWESOME tomatoes among other fresh veggies (and mangos in a couple months!). I’ve recently started eating them with cucumber, onions, feta cheese and balsamic/salt/pepper – delicious minus the onion breath. Here are some pics from the market, which I’ve recently learned is the one that rips people off - guess I’ll be going elsewhere from now on.

1 month!?

WOW! I’ve been here for a month!! This week my family goes to Quimby’s in Vermont and it’s the first year that I am missing the vacation. I’m kind of bummed but on the other hand I’m having a great time. The rest of the fellow/scholars are getting here this week and next. I’m excited to meet everyone. Life has been kind of quiet though since the fuel shortage continues and I’m too lazy to go wait in line for 10 hours to fill up and hope there are drops left. Plus, were I to go out of town, I would have to find petrol again since we would use it all getting to wherever we went and back. Apparently the government’s lack of foreign exchange is due to the really really bad tobacco crop this year so I might be dealing with petrol issues for the entire year.

The last weekend in August I’m hoping to go to the Lake – maybe Nkhota Bay in the north – since there’s a holiday (Eid) that Tuesday. If I take off Monday, I’ll have a nice 4 day weekend to relax and explore. We’ll see though…

Getting started on the study has been slow – we’re still working with the database guy to get that finished so I currently don’t have much to do besides hassling him to make the changes. On the one hand, no data to enter (yes!) but on the other hand that means I’m going a little crazy from boredom (nooo…). Also, if I come up with a good idea, I might be able to do my own project (with potential funding)!!

In other news, I’ve failed in my attempts to coffee detox so I’m now drinking really awful Malawian coffee since that’s all I can afford (ahem Mom, if you visit, please bring me some good coffee!!). I’m playing ultimate Frisbee and I went on a 3 mile run the other day! Big progress, I’m pretty stoked. The guesthouse is right beside the Wildlife Centre, which has about 6km trails through the woods. It’s gated off and safe so I can run with an ipod and in shorts, instead of running on the side of the road with no music and wearing leggings with shorts on top so people won’t yell at me. People also try to hug you. This doesn’t go over very well considering my suspicious attitude towards strangers… Although Lilongwe is a pretty sleepy town/city, there are a couple clubs and bars. The other night we went to pub quiz, which was pretty fun. There’s also jazz at one of the hotels on Sunday evenings. 

Here's what I'm doing

I finally found out what I am going to be doing! I met with Eric on Friday after our meeting was delayed all week for various reasons (flight issues, demonstrations, the usual). His study is comparing two ways in determining when to start infants on antiretroviral therapy (ART). Generally, babies should be started on ART asap. The participants were recruited from the inpatient wards and have been exposed to HIV through their mothers. Since infants have their mother’s antibodies, the rapid antibody tests cannot be used - tests must directly detect the presence of HIV.

The 2 arms of the study are the standard of care and point of care RNA tests. Right now, the standard of care is that babies are HIV tested with dried blood spot DNA PCR that is sent to a government lab, but this test takes at least a month to get results back (meaning increased chances of the patient being lost to follow-up). Whether to start the infant on ART is determined by whether the baby is symptomatic and then given a presumptive diagnosis.

POC RNA tests are not yet available but will be soon. The UNC Project lab, however, can turn over these lab results in about 48 hours. Since the participants are inpatient, this method is being considered as POC for the purposes of the study. These tests mean that an HIV diagnosis can be given immediately and ART can be started, but they are more expensive and require higher technology. When the test comes out, this study could provide valuable information on whether the government should change their policies.

What exactly will I be doing until December? In the mornings I am going to shadow and get some clinical experience/exposure (I even get my own stethoscope!). If I get bored, I can also organize other things to do, maybe see some surgeries or find a way to make some money. Then (after a 2 hour lunch break, score) in the afternoons I will be working on the study database and entering in data. Although this part will probably be tedious, I think it will allow me ways to figure things out, learn about clinical research, and hopefully give me ideas of other ways I could contribute to the study. 

Democracy in action?

Malawians protested against the President Wednesday (7/20) in the 3 major cities – Lilongwe, Blantyre, and Mzuzu. From what I understand, this is what happened (or you can google it) though I am incredibly skeptical of everything I have heard, including the sensationalized and underplayed.

Smoke from burning tire blockades, as seen from the guest house.

It was intended to be a peaceful demonstration criticizing recent power plays by the President/administration, the complete lack of fuel (and foreign currency to buy it), poor economic policies, the absence of medicines at the hospitals, etc. The night before the demonstration, the courts put in place an injunction banning demonstrations. I awoke that morning to sirens blaring around the city. The riot police were out in full force that morning arresting people in the streets and anyone wearing red (the color of the opposition). Later that morning and throughout the day, we could hear jeering and gun shots from the guesthouse, and there was smoke in the air from where people were burning the police’s tire barricades. We heard through the grapevine that the police were using tear gas, were beating people and many bystanders were getting hit by stray bullets. People were burning down police officers’ houses in retaliation. The violence lasted until yesterday when the army moved in.

Needless to say, I stayed at the guesthouse. I’m safe! Don’t worry!!

What is interesting is that the people protesting were exercising their constitutional right to peacefully demonstrate. The President, however, compared these actions to those of Satan and declared that he had the power vested in him by the Constitution to maintain peace in the country, which apparently means squashing dissenters. Every Malawian I have spoken to seems really frustrated by the state of things in this country and the direction it is going in. People took a stand and it seems like some news outlets actually picked up on it, perhaps the government will be held more accountable. 

Hello! Moni!

Hello!

UNC guesthouse (note the volleyball net)

Sorry for the delay – I’ve been getting situated. For example, I was at the bank for 3 hours one day opening an account (I should have brought lots of cash…). Lilongwe so far is great but COLD (its winter)! There is currently a fuel crisis (Lilongwe is practically dry), making getting around town a little difficult and our weekend plans are now up in the air since we might not have enough gas to leave the city.

My room (Mom. I know it's messy.)

I’m staying at the UNC guesthouse, which is right on the Kamuzu Central Hospital campus where I will be working. The guesthouse is great – I have my own room, there is hot water, satellite tv, wifi, and since we are on the hospital power grid our electricity isn’t always subject to the rolling blackouts (plus we have a generator just in case). If I’m going to be here for a year, might as well be comfortable. There are also 4 other students/fellows here at the moment. They are leaving soon, but the year-long trainees will arrive sometime in August I think.

A glimpse of Kamuzu Central Hospital (KCH)

The PI (Eric) on the study I will be working on (to be discussed next week) is on vacation, so this week I have been tagging along with one of the study clinicians, Mada. I sit in on the outpatient and inpatient check-ups, which pretty much consist of taking the baby’s temperature, weight, blood pressure, and counting pills to determine adherence. To weigh the baby, the mother first stands on the bathroom scale (weight is recorded), then she stands on it with the baby. I was in charge of determining the difference (I’m so useful!). We also see a set of preemie twins in the nursery – my new favorite place since its really warm.  Today I went and checked out the STI clinic, I loved it! The clinic is pretty much run by UNC Project staff and they are doing some really neat studies on acute HIV testing (antibody vs RNA tests) and social networking.

Other fun tidbits:

• I went RUNNING the other day for like 5 minutes and survived (sort of).
• I’m back on a honey craze
• I’m back to being called Maddy (ahem Edinburgh people) since Madeline is kind of hard for people to say
• I need to learn to check expiration dates. The grocery store doesn’t…