Pictures

Baby post c-section being held by female relative of the mother. (Photo taken with permission).
Why you have to change into rubber rain boots before doing a c-section (frequently a bloody/messy procedure).
Before assisting with a c-section.
Catholicism and Medicine have never been combined so well as the crucified Jesus above an eye chart and patient intake table.

Picture from around Mua

This is a picture that I took about a week ago while on a walk around sunset.

Antenatal Clinic prescriptions

I have been struggling with uploading pictures to my blog (it takes a bit of time), but today I spent some time in the antenatal clinic at Mua Hospital. We saw so many pregnant women. Here are the prescriptions given out:
1) Iron+Folic acid (the little red pills). Women take 1 a day for the duration of the pregnancy to prevent anemia (a terrible problem with the amount of Malaria that is around) and promote proper development of the fetus.
2) Albendazole (one dose). Given to eliminate worms.
3) SP (3 pills taken twice during the pregnancy). This is part of the intermittent treatment of Malaria in Malawi. Attempting to reduce Malaria in pregnant women (who are very susceptible).

You can see a woman getting her blood pressure taken in the background. (They also get weighed).

At a different station the women can get 1 free mosquito net (paid for by UNICEF?) and immunizations. A different room provides confidential HIV testing and counseling (done twice during a pregnancy). A final exam room is where the abdomen is palpated and a fetoscope is used to listen to the fetal heart rate.

Arresting Jesus with an AK-47

Yesterday I was privileged to go to a church services in the village in which they celebrated Good Friday by reenacting the Passion (the story of the how Jesus was betrayed, arrested, sentenced, abused and crucified). It was a very touching performance that was both very meditative and beautiful. It lasted for about 2 hours with the performance (in Chichewa, the local language) interrupted periodically with singing from the choir. There were some interesting cultural references and interpretations. One of them was when Jesus was arrested in the garden, the soldiers weren’t carrying spears or swords (perhaps weapons that Americans might view as more historically accurate for the time period), but the soldiers were carrying wooden cutouts of Ak-47 guns. I thought that this was hilarious and also an interesting cultural interpretation of what “a solider” described in the Bible is to them.

Another, perhaps more distressing, cultural difference in the portrayal of the Passion that I witnessed last night, was in the treatment of the actor playing Jesus. The other actors literally beat him up. While in the United States if there was play in which one actor is supposed to hit another, there might be some encouragement/understanding among the director and performers that you will just PRETEND to hit the actor. Not so in this performance. They had branches and were hitting the Jesus actor full-force. They also pushed him to the ground a number of times. I asked the priest about this later. He said that there is informed consent for the actor who plays Jesus – he knows ahead of time that he will be beaten up. In fact, the same actor has played Jesus a number of years in a row, so he knows what he is in for. Sigh. The cost of fame.

The crucifixion. Yes, they actually did tie the Jesus actor to the cross.



Judas betraying Jesus to the priests guarded by the AK-17 wielding soldier.

A nice kind of offering

Since I am staying with the priests while I am working at MUA Hospital, I have enjoyed getting the opportunities to go to several masses in the rural community. It is a really beautiful experience. Since the services are in Chichewa, it can be difficult to follow what is going on at times.

Since most of Malawi is rural (something like 85% of the population lives in rural areas), a lot of the population engages in subsistence agriculture (meaning that they grow food for themselves and their families). With this knowledge it makes sense that many people don't have any money to give during the offering at church. So what they do in many churches in the area is bring an offering of some type of food. This usually takes the form of maize (the primary staple food) or groundnuts (peanuts). However, many other things can be brought such as tomatoes, bananas, other fruit. The priest blesses the offering that each person brings and then passes them to the alter boys to be put on the alter.


Children outside of a village church.



A picture of the offering. It was sort-of dark so the picture didn't turn out that well, but you get the idea of how beautiful the offering is.

Sorry about the long gap in posting

Hi to all (2-5) of my blog-readers out there. I am sorry that it has been so long since I have posted anything. I am back in Africa for the 4th time and want to start blogging again. However, I thought that perhaps I should give you all a brief update since I last posted. My international rotation in Malawi is going to be my last rotation in medical school. During the end of third year and the beginning of 4th year, I wrestled with my top 3 specialty choices: Family medicine, OB/GYN and peds. I decided to apply to family medicine. After a long journey that involved 10 residency interviews and a impressive increase to my Alaska Airlines frequent flier miles, I concluded the residency application process and just had to await where the "Match." Would place me for residency. The match is a computer program that matches residency applicants and residency programs together based on rank lists that they have all created. The "Match Day" is when all the graduating medical students find out where they have matched for residency. This year it was on March 17th. I was very nervous, but I was thrilled to discover that I matched at the University of Washington for my family medicine residency. I think it will be a perfect fit for my interests and am really looking forward to meeting my fellow incoming residents.

After the match I just had to finish up my chronic care rotation (which I did through hospice), pack up and then I was off to Malawi. My original flight had be flying from Seattle to Paris, then from Paris to Ethiopia and then from Ethiopia to Lilongwe, Malawi. However, a last minute cancellation meant that I had to add to fly from Seattle --> Amsterdam --> Paris --> Ethiopia --> Malawi. It was a VERY long journey, but I finally made it! I am still a little jet lagged, but am looking forward to sharing my experiences with all of you.

More soon...

YAY! Going to Malawi spring of next year!

Yeah! I recently found out that I will be going back to Africa during my 4th year of medical school! I applied for the international 4th year clerkship abroad program at our school. I requested that I go to Malawi (my first choice), Ghana, or Uganda for 5-6weeks in the spring of 4th year. I was just informed that I will get to do the clerkship in Malawi. Malawi is was my first trip to Africa in 2004 (during my undergrad years). Malawi is one of the 10 poorest countries in the world and has a higher HIV prevalence rate than Uganda. I think I will be going to an area in the more southern region of the country (possibly Mangochi district). I am sure it will be a great experience. It will be fun as I make preparations and try to brush up on some Chichewa (the official language of Malawi, which is in the same Bantu language family as Swahili). I try to give more updates as more information about my Malawi trip becomes available.

Despite having lived in Africa, My PPD turned positive in med school. BUT I DON'T HAVE TB! Whew.

Recently I had my annual PPD test placed. The area became red and irritated, as always occurs for me, but then something truly horrible happened - it became raised. Not much, but there was a definite bump under my skin. I went in to have it read and to my utter horror it was read as positive. I was justly upset at the possibility of having tuberculosis and had much to ponder as I waited for my chest xray. It just seemed so ironic to me that despite having lived for a total of a year in Africa, that my PPD test would turn positive during the third year of medical school! I had not 1, but 2, negative PPD tests since returning from last adventure in Africa, so it would have to mean that got infected during med school. Still fuming at my bad luck, I went with much indignation to my TB treatment program visit. There I was offered a blood test to confirm that I actually did have TB before I had to take 9 months of a slightly nasty drug called INH (isoniazid). I got the quantiferon TB test, and it turned out to be negative. Today I got the bill for the test: $102.84. I wonder if that goes in the miscellaneous column of my medical education expenses.



A map of TB prevalence by country. Notice that the East African countries I have worked in have a MUCH higher rate of TB prevalence than the US. Good times.



A positive PPD test. This is not a picture of my arm (image from google image search), but the raised area is similar to what I experienced.

Temporary tattoos and teddy bears named 'teddy bear'

On my pediatrics rotation I got to take care of some of the cutest kids. When I say cute, I mean cute. Some of these kids were so adorable, they put the Welches Grapefruit juice commercial kids to shame. One three year old girl had bright eyes, thick black hair and cute dimples when she smiled. When I went in to listen to her lungs, I found her carefully clutching a little Teddy Bear. She seemed shy, but also happy to interact despite being on oxygen. I tried to strike up a conversation by asking, "That's a nice Teddy Bear you have there. What is his name?" My 3 year old patient responded with a look that clearly indicated she thought I was a little bit stupid and said, "Teddy Bear." The little girl's mom smiled and said, "Yeah, we are going through a real creative period right now."

A couple days later I came in to check on this same patient. I asked my three year old patient, "How are you today?" She responded in very cute high squeaky voice: "Bedder." She was so cute I tried to go through the process of getting a picture taken with her to share (this involves a signed consent from mom as well as some other paperwork), but my patient improved so much that she was discharged the same day so I didn't get a chance to do the photo shoot.

A few weeks later I had a 4 year old patient who was very sick and hated being examined, taking her medications and getting nebulizer treatments. However, this patient absolutely loved temporary tattoos. So her parents had a very sizable selection of temporary girly tattoos (pink flowers, stars, happy animals, etc) that she could pick from after cooperating with a medical exam or treatment. It worked really well. After a couple days, I guess she started to like me because after I examined her in the morning, she asked her dad to show her the tattoo collection and picked one out just for me. (If you are wonder, yes, this was a highlight of my pediatrics rotation). I walked around the rest of the day as the proud owner of a pink flowers and stars temporary tattoo. The tattoo was cute on the peds floor, but it got some strange looks outside the hospital!

This is just a sampling of some of the cute-kid interactions I had.

The upside of having a family that is a festering cesspool of viral illness

I always get sick when I go home and visit my family. Always! In the past I have found it very irritating. You have a free weekend a couple weeks before finals and go up to see the fam. You arrive and an adoring sister with copious nasal discharge gives you a huge hug and proceeds to use your jacket as a make-shift kleenex for her nose. 3 days later you go back to your house in Seattle, develop a sore throat, runny nose and a fever and you realize you have killer viral illness #8 of the season. 10 days later you feel better, but not before giving said killer viral illness to several classmates, undoubtedly resulting in the loss of a couple friendships. A couple months later, all is forgotten and you go home to visit the family again, only to have the process repeated.

HOWEVER, on my peds rotation it came in handy. And when I say handy, I mean really handy. The other medical student on my pediatrics rotation fell seriously ill, not once but twice. He developed a high fever resulting in the inability to get out of bed for several days, and actual hallucinations. During this time I also developed a little bit of a scratchy throat for a day or two which quickly resolved. It seemed like my body was fighting off a lesser version of something awful it had encountered before. (I don't mean to imply that I have a killer immune system or that I never get sick. I actually get sick a lot, it is just that pediatrics clinic can't hold a candle to the immune challenge you get from hangin' with a family that has 13 kids).

Apparently, it is very common for medical students to fall very ill during their pediatrics rotation. We were warned about this, and staff commented that the acquiring of severe illness from peds clinic seems to occur more often with people who are only children growing up or had fairly clean living environments. Well, not a problem here! :)
Here my (fun and terrific) family has been labeled by name. However, perhaps the could also each be labeled as "Immune challenge #1," "Immune challenge #2," etc.