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.