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.