Zanzibar

Last Saturday, I left for Zanzibar (aka heaven), an island off the coast of mainland Tanzania in the Indian Ocean. So it probably seems like I never work, but I do! My friend Laura and I left on Saturday and arrived in Stone Town early early Sunday morning. We crashed then headed out to the northern beach town of Kendwa. We stayed there for a week. This place was AWESOME (see pic). I spent 4 days getting dive certified and saw a bunch of reef fish and even a stingray. Once my housemate Bryce arrived after hiking Kili, we went to a small island to the east of the main island called Mnemba and dove at the reefs there. The coral was beautiful and I got to put my underwater camera/case to work. After several days of white sands, clear teal water, blue skies, fishies, seafood, and uncountable tropical beverages, we headed back to Stone Town for 2 days. 

Mnemba Atoll

Nemo!

On the way back, we made a stop at a spice farm where we saw the different plants that Zanzibar spices come from. Pretty cool!

Nutmeg, the red plastic-y stuff is a spice called mace

Stone Town is the main city in Zanzibar and an UNESCO world heritage site. The city is very walkable with winding cobbled streets and beautiful (but deteriorating) architecture. The number of restaurants and cafes was unbelievable and the seafood and food in general was delicious. There is a park on the water that has a food market with tons of seafood, meat, and Zanzibar pizza stands. The seafood was SO good. I got mahi mahi, masala lobster, masala octopus and calamari, baby shark, and barracuda. Then I got either ice cream or banana and nutella Zanzibar pizza for dessert. YUM. I was in pure heaven. 

Zanzibar door

FRESH SEAFOOD!!

As a side note, it was very strange how much better off Tanzania is than Malawi. There was fairly consistent electricity, and at least when it went out, it did went off and on at consistent times. Everything was pretty affordable and you could get US dollars. The food was amazing and there was a wide variety of (fresh!) options. Most people spoke very good English. And most importantly, the gas stations had fuel and there were NO lines! When I went back to the US, I thought, oh that's just how things are in Malawi. But after going to Zanzibar, it became very clear how much better things could be. But I guess, hakuna matata (I learned some Swahili, probably rivals my Chichewa at this point). 

Mumbo Island

Hello! The past month or so since I last wrote has been pretty hectic. The power has been going out almost everyday but at least its cooler at night. The GeneXpert arrived so the TB and malnutrition project started. This study is insane. Right now I'm mostly helping to enroll kids for the 2.5 days per week I work on the study. This entails finding possible participants, giving the study spiel, having the interpretor consent the parents, scouring the illegible passbooks and charts to take a history, and interviewing the parents. As an aside, we recently had one family that immigrated from the DRC and I attempted (and sort  succeeded) to conduct the whole process in French.

Most parents are very willing to have their kids join the study (I think 99% of the Nutritional Rehabilitation Unit - NRU - have our green sheets stapled to their charts). At first, parents were reluctant because of the tube we stick down the child's nose to suck out the sputum but we've since reworked how we talk about the induced sputum process. Many people associate NG tubes (the ones you stick down the nose usually to feed a kid who won't eat) with death since those who have them are really really sick, and our sputum sucker was sort of like that. We enroll kids who have severe malnutrition characterized by one or more of the following: weight for height < 3 standard deviations per WHO guidelines, a MUAC < 11.5 cm, and/or bilateral edema (swelling of the feet, legs, and/or head). There are 3 types of kids we see - those with marasmus (wasting), kwashiorkor (swelling), or both. The malnourished kids are really sick and a good chunk of the ones enrolled in the study have died while in the hospital.

In general, the pediatric wards are incredibly crazy right now. The wards that we recruit from are jam packed with kids and their parents. Most of the children admitted seem to be under 5 yrs.  Then there is the treatment room and it's pretty clear that if a kid spends some quality time there it's not a good sign. The wards smell and I swear every time I leave to come home, I have a layer of grime on my skin. I really enjoy the excitement of the wards, but I also find it pretty stressful and I'm very happy spending half of my week in the outpatient (and air conditioned!) Baylor clinic.

We stayed in these permanent tent structures (this one is mine).

One good thing about the rains are the "green season specials." A lot of different lodges and destinations in Malawi and elsewhere are having discounted packages since the rains are unpredictable (or predictably everyday) and occupancy is down. This past weekend, I went with 3 of my housemates to Mumbo Island, about a 30 minute boat ride from Cape Maclear. This place was AWESOME. The island is within the national park, so the beach, sand, and water were totally pristine. The food was also great and we were the only ones on the island the night we stayed there. I snorkeled some, checked out the cichlids, and got to test out my underwater camera case.

cichlids!

more cichlids.

View of the Lake from my tent

Come to Malawi!!

Happy New Year!

After spending a 3 week vacation over the holidays in the States, I am now back at work. Not much has changed in Malawi while I was gone except for the wards and it seems like there are a lot more expats at the Shack that I don't recognize. Pediatric Ward A (the acute ward) has drastically changed. I took one step in that place and the (even worse) stench, hot humid air, and sounds of crying babies was so overwhelming that I had to take a quick break in the hallway before checking the place out. It smelled. bad. After taking a breather, I went in and assessed the differences. Malawi is now in the "green season" and with the rains come malaria, malnutrition, and other sicknesses. Instead of there being 2 babies to a bed (plus mom), there are 3 babies per bed and more beds in the ward, it's pretty crowded and a lot of the kids do not look good. It's only the beginning, so I can't imagine what the ward will look like in the coming weeks and how crazy the study I'm working on will be.

In other news, I went to the high risk nursery today with Amy to echo conjoined twins. They were born the night before and were connected by the front of the chest. They each had a set of arms (so it looked like they were hugging each other), but only had one set of legs. It was almost as if the bottom half forgot to split. Pretty crazy!

I am also now working on 2 different projects, both pediatric. One is on HIV and cardiac function based in the Baylor HIV clinic, so more of an outpatient setting. The other is on TB and malnutrition among inpatient kids on Ward A and should be pretty hectic. Should be an exciting next 5 months!