#2

Hello hello,

Looks like my blogging attempt has yet again fallen by the wayside.  Here's an update, however delayed beyond the writing schedule I had hoped to keep:

On my first day of work, I got a quick tour of the "FHU" (family health unit) where all of the antenatal care visit happen at the hospital where our study team is based. The clinic is packed, full of women and babies dressed and draped in the brightly colored chitenge fabrics.  It's not often that I have to navigate through the crowd so densely packed in North Carolina.  I got a tour of the clinic and a crash course on the electronic medical record (EMR) system, and saw first hand how it has been simultaneously helpful and frustrating for the already overburdened clinic staff to start using (instead of only using paper charts).
The hospital where I work is about a 15 minute drive away from where I stay at the UNC guesthouse.  I originally was getting transport with the lab specimens that get sent from one hospital to the other , but it ended up eating up a lot of time due to the lack of set schedule for when a car would be driving from one place to the other.  "Transport is leaving in 15 minutes" inevitably turned into an hour on average, and I'm just not that good at waiting, especially when I have things I need to be doing while the sun is up and people are available.  While I was initially reluctant to plunk gas money into driving myself when there is a car that goes between the two campuses, it has been worth it to have the schedule flexibility and predictability.

Overall, I'm very glad I came here and have had the chance to work with the study team on the ground as we started enrolling participants.  Some days are great-- inspiring, productive, and fun.  Other days are frustrating on a number of levels that is hard to quantify.  Last week my gristly cube of beef at lunch matched the gristly feeling I had about work that day, seeming to be something that got even more mangled despite my careful attempts at separating the chewable protein from the much less chewable fat and fascia.  Maybe a non-top quality beef bit is a plug for vegetarianism, but overall the lunches here are really good, especially for the price.  Generally, the BBQ chicken is the most reliable and is actually really darn good, but they were all out that day.
Anyway, as I sat at the table seeking the perfect ratio of nsima (think grits made with less water so you can pinch off a lump with your fingers), sauteed pumpkin leaves and grizzlebeef with each bite, I felt a gradual sense of unwinding about the research-related items that were grating on me.  A few years ago while in Zanzibar, my mentor and I were discussing our research team members and how the work had been going so far when she said it took her a while to realize that it's important to know when not to use yourself as a baseline for how you evaluate whatever's at hand.  I too have found it to be good advice, but sometimes struggle to identify whose perspective to use if not my own.
During the ongoing attempt to figure out which cut of beef my gristle came from, some portions out of view by the onions and tomato skins of the stew it was cooked in, I thought about what comes to mind with our research team from Zanzibar now, 5 years later. I realized that having everyone on the current team feel positive about their contributions is probably more important at this point than addressing every specific mistake in our operations.  I like addressing those little things in the same way that scrubbing the bottoms of the cooking pots until they're shiny makes me oddly satisfied, but it's not always the best use of my time or elbow grease.
Did I approach nirvana in gristle-filled beef? (and is nirvana allowed to involve the sacred cow in its butchered form?)  Okay, so maybe not nirvana, but at least a healthier approach to the situation.   The afternoon felt easier after that lunch.  I don't think I'll get the beef again, unless for therapeutic reasons.

Only three weeks left here until a bit of time with the family in Maine.  I'll try to write again, if only to give an update on the lunchtime thought wanderings.
To end on a high note, I found Stoney Tangawizi (ginger beer that I love) here in Malawi. It wasn't here two years ago, and I fully support this version of Coca-Cola-ization, because Stoney's just so darn good.  Like many packaged food items available here, it's packaged for sale in South Africa, having the price in rand and some slang I don't understand.  But that super spicy ginger flavor is divine, and is well-worth the sneeze that it usually causes because it's so peppery and fizzy.

Back on the blog train

Hello hello,

I'm back for another summer in Lilongwe, Malawi until mid-July. I arrived on Wednesday May 13th after the typical 26+ hour transit from North Carolina to Lilongwe.  Packing always takes me longer than I think it will, and I ended up running errands until 11pm the night before, and just stayed up packing & puttering around until my 3am departure on Tuesday.  In a way, totally wrecking my sense of time on the front end makes it easier to adjust to the new time zone.

It has been fun to get used to the daytime heat with chilly nights that are typical this time of the year (it's "winter" here, which is still warmer than a Maine summer).  I've gotten back into playing ultimate frisbee with the pick-up league here on Thursdays and Sundays, which quickly made me realize that I'm not in the best sprinting shape.  Unfortunately, the sun sets at 530pm here, not leaving much time for frisbee on Thursdays after work.  Luckily, my boss is the one who organizes it so she allows us to leave early that day.  I forgot about the early sunset and exactly how far the running loop I like was on my first day here and had the last half of my run mostly in the heavy twilight.  It gets super dark here at night on the roads because many stretches of roads don't have streetlights, and while Lilongwe is the capital city, it's not a place that's permeated with light.  Not good for running, in addition to the safety issues of being on your own here after the sun sets.

At around 8 or 9pm, the sweet scent of the Night Queen flowers, a potent form of jasmine that is sometimes too strong, trickles into the guesthouse common room.  I get an unmistakable waft when I go past the plant to feed the dog each night, a sweet but geriatric animal named Mfumu (king).  I tried to teach him to sit before getting his food, but his arthritis is too bad and I decided his calm standing and waiting for the food was good enough.  I do miss my puppy Moose back in Chapel Hill!

And finally, I forgot the excitement that comes with the "how actually bruised is that banana?" game.  I found a bunch of small bananas yesterday and was a bit skeptical, almost to the point of not buying them because all were quite brown on their undersides despite their green tinged stems. But they're a good breakfast & snack food, so I got them.  This morning when I woke up, I decided to take the brownest banana of the bunch, just to get it out of the way...

To my delight, it was practically unscathed: 

I know this probably doesn't fall into the "exciting" category for most people, but I'm going to take it for the small joy it brings.  The skins on the bananas here are certainly better at protecting the inside fruit from the insults they receive in transit than what we can buy in the US.

Mini-Chichewa lesson: the word for "danger" in Chichewa is "poopsya" or "poopsa".  That is all.

Back in the US

Good morning, I arrived safely in Boston after a 36 hour transit from Dar es Salaam, Tanzania.  I'm very much looking forward to a change of clothes and a shower.  I have one choice for a change of clothes given that my two checked bags didn't make the transfer from JFK in NYC to Boston.  This is disappointing, as I even sprang the $5 for the smart cart to schlep them between baggage claim, customs, and baggage re-check.  Oh well.  My way of getting back at the system?  Eating my undeclared foreign agricultural products (apple & peanut butter) from Malawi that I stashed in my carry-on.  Fun fact, peanut butter doesn't flag the security check point scanners as being a liquid; 3-oz rule doesn't apply to this portable nutritious faux-liquid.  Good thing I still have the plastic spnife (one end is a spoon, other is a knife) from a few years ago that my mom gave me; it's made specifically for eating kiwi fruits, but it does a nice job of spreading PB on my apple as I soak up this free wifi at Logan airport. 
The trek from Dar to Boston went pretty smoothly.  I had 12 hours at the Johannesburg airport, and I think I found all the free samples that were there: body lotion, Toblerone crunchy almond chocolate, another less well-known chocolate, homemade gourmet marshmallows and Three Ships whiskey.  I did some shopping, read, drafted some emails, walked around, listened to tracks from almost every CD on audio display at the music shop, and painted my toenails in the 3-4pm (ish) lull in the airport corridor.  Highlight of my day: finding Stoney Tangawizi, a spicy ginger beer that I've only found in certain parts of Eastern & Southern Africa, in a plastic 500ml bottle for sale next to my departure gate.  I was looking forward to enjoying sips on the 16 hour haul between Jo'burg and JFK, but then had a surprise security check before boarding and had to sit and drink it before I got on the plane.  I guess it was a good thing that I was given an aisle seat.
My seat mate on the plane was an HR admin for Doctors Without Borders who is from France but based in NYC now.  We had a good time chatting about the organization, and some cultural items we each noticed from living & working in France & the US.  She noted that it still surprises her when she sees people walking and eating or drinking, reasoning that if you don't have the 5 minutes to stop and enjoy your food or beverage, just don't have it at all because you probably can't really enjoy it when you're on the go.  Also with food, she finds that Americans micromanage their food & exercise, seeing them as utilitarian (ie: how many calories? is it gluten-free?) rather than whole and enjoyable (ie: does this food taste good? am I hungry for it?)  One thing she appreciates about living in NYC is that she rarely gets asked "where are you from?" when people hear her French accent, because there is such a breadth of accents that can be heard daily there.  Along with that, she said she admires how adaptable many Americans are compared to the French culture, which she finds to be more concerned with preserving the way of life as it has been.  

Arriving back in the US-- land of the free and home of the baked bean, as my dad's 'welcome back' text message said--  has felt easy yet slightly surreal.  These past two months have flown by, but finishing up the 1st year of med school seems like quite a while ago.  I feel very lucky to be from the US and have it as my home, and also lucky to have had (and hopefully will continue to have) the opportunities to travel for work and research.
I should scoot so I can make sure to get my bus up to Maine, then go to my family friend's wedding this afternoon! I'll continue to try to finish posting the blog entries that I've drafted over the summer.  Hope you're all well!

back (b)logged: May 31- Chichewa

Hello from my blissfully introverted Friday evening here in Lilongwe.  My housemates have gone to hike Mt Mulanje, the highest mountain in Malawi and I am enjoying the solitude (they're an easy group of people to live with, I am just enjoying the quiet... literally, listening to the crickets chirping outside my window).  It's a long weekend in celebration of Malawi's independence day (July 6th), with 2013 being the 49th anniversary. There are signs at every major round about in town painted in the black, red and green of the Malawian flag.  If I pass one when I'm not the driver, I'll snap a photo and post it.  
Anyway, here's another bit I wrote shortly after arriving in late May. 

There are many languages spoken in Malawi, but the most common two are Chichewa and English.  Hearing Chichewa reminds me of being in Kenya & Tanzania when I was first learning Swahili.  This time around, the rhythm of the words, verbal non-word interjections & expressions, and the physical aspects of communication are already familiar.  It’s a bit discomforting to recognize these trends with the similar visual cues (such as the fresh produce market scene) but not being able to catch the content of the conversations I hear.   I can pick out a handful of words that are similar to Swahili, but largely I feel as though I've reverted back to being a child who has sub-par vocabulary.  A very seriously sub-par vocabulary.
I’ve been told that English is more widely spoken in Malawi than in Tanzania (although this can be dependent on the person’s education level), but I have already noticed the “super omniscience” that comes when I overhear a conversation in English amidst the softer rumblings of Chichewa: the fact that I can understand every English word when I’m not participating in the conversation makes me feel privileged, almost like I shouldn’t be listening.  Maybe I should tune out, but there's a fair amount of Chichenglish spoken by Malawians, so listening for English words is helpful for those conversations too. 

When in the hospital on ward rounds, my lack of facility with the Chichewa language means that my observations about intonation, tone, eye contact, and accompanying physical gestures are the basis of what I can understand from the verbal exchanges between the staff and the patients.  I eventually get a summary version from the physician or clinical officer about what is being discussed, but in a way, it's refreshing to take the first few minutes at a patient's bedside just watching him or her.  I sometimes count the patient's respiratory rate if it looks like the person is having any trouble breathing.  From starting to review patient charts from April & May for my research project, I think respiratory rate wins the prize as the most often neglected vital sign, at least in terms of what is recorded in the chart.
Patients tend to remain quiet when the staff are reviewing their files, not interjecting unless asked a question directly.  Almost always, each patient has a guardian there.  This person is in charge of bringing any food the patient needs outside of the meal the hospital provides, changing the patient's bedding & clothes, going to the pharmacy to buy needed medicines that the ward doesn't have, answering questions to complement the history the patient can provide (which sometimes is minimal if the person is really sick), and hopefully is someone who understands the treatment plan and can help the patient with it.  The guardians can also be a helpful source of information by their mere presence or absence, offering some insight into the patient's social support system.
My interpretation of my observations is slowly becoming more appropriate for how people interact here in Malawi rather than considering them in an American framework.  Overall, people here are incredibly polite.  Sometimes this seems to manifest as patients refraining from asking questions so as not to come across as challenging the doctor's words.  I'm learning that direct eye contact doesn't necessarily signify confidence as it generally can in the US, but can actually show disrespect in some cases.  I anticipate that throughout my time here, I'll come to understand other cues in their local contexts, and will hopefully be able to add those to my bedside observations (and respiratory rate counts).

Will keep on trying to get these posts uploaded, along with some pictures.
 

back(b)logged: May 28

Backlogged blog thoughts: will try to post these as I can!

May 28:

I arrived in Lilongwe after a 24 hour transit between North Carolina, NYC, and Johannesburg.  I spent my last days in the US as anyone would: packing frantically.  I partially moved to my new place (ie: bed, dresser and kitchen items for the summer subletter to use), but mostly did a shuttle run between my bedroom and the attic at the place I lived this past year.  I got quite skilled at balancing and hoisting heavy boxes up the narrow ladder, up to the incredibly humid attic crawl space.  I was lucky enough to have a few friends help me move the big furniture items to the new place, which we celebrated with some Merritt’s BLTs (as if UNC students needed another excuse to indulge there).  I sent a flurry of emails to take advantage of my last wifi juice in the US before leaving the house at 3am to drive to the airport and start the trek.   The two guys behind me at check in were speaking Swahili, and were surprised when I indicated that I understood what they were saying.  They were college students heading back to Kenya to visit family for the first time in seven years.  It made me a bit sad that I wasn’t going to the Swahiliphone world.

I arrived in Malawi after a pretty uneventful set of flights, tired more than anything else because I wasn’t able to sleep much on the 16-hour flight between NYC and Jo’burg.   Looking out the window from the left side of the road during the ~30km drive from the airport to the UNC guest house felt more normal than I had anticipated.  What struck me as I saw them were the following: ubiquitous close tailgating (and the broader difference in concept of what personal space is), the relative social acceptability of gently picking one’s nose, and being in a land where it’s practically a human right to have a toothpick after a meal (grisly meat, although almost always more flavorful than what you get in the US, is at a new level here).   Like in Tanzania and Kenya, round-abouts are favored more than traffic lights, and a car honk is more of a “hey- I’m here” rather than carrying a message of annoyance or anger as it tends to in the US.  Even on the major highways, which usually have just a single lane in each direction, people walk or bicycle along the shoulder, or in the road if the shoulder has eroded away.  Hence, lots of honking and gentle swerving, and zero autopilot mode when in driving here.

 A pic my copilot took when driving back from a hike a few weekends ago: a different take on road-side food offerings

That evening, I went on a jog with two other students who have been here almost a year.  I learned that along the trails and footpaths here, there are bridge tolls (equivalent to about $0.06) that are charged by whichever local person or family has secured such rights to the bridge.  We stayed close to the guest house & hospital to avoid these tolls, and because the sky was already replacing its pale blue with a sherbet striation of orange, pink, and purple.  (Nora, we could even see Venus!  Hold back your excitement…)

Overall, settling in went smoothly.  I slept well that night after diligently tucking in my mosquito net.  I’ve since become incredibly lazy about using it.  Since I don’t move around much when I sleep, I don’t ever get close enough to provide a muzzy with a blood meal through the net.  Perhaps I should be more concerned, as mosquitoes have about a 2 mile home radius, and I’m only a few hundred meters from the main public hospital that sees plenty of malaria admissions daily…but when I leave the royal blue net a bit slack, it looks like I’m underneath a skirt of jellyfish tentacles, which is probably the only time to be mildly excited about being underneath a set of 5+ foot long tentacles. 

Anyway, I’ll try to outline some impressions from being at the hospital in the next posts.   Until then, keep on keeping on.

reawakening the blog action

Hello from Lilongwe, Malawi!

My internet finally let me through to this site to create a new blog, just as I was about ready to start tacking onto my blog from my time in Zanzibar in 2009-2010 & 2011.  I figured it would be good to start anew, though if anyone's just so keen on checking that blog out, feel free. I suppose like my Znz blog, a recurring theme in this blog will also be my internet connection, or perhaps lack thereof.

In order to not pull any blogging muscles while I'm writing for the first time in two years, I won't write too much.

The Swahili proverb at the top of the blog is one I first heard when recounting to a friend my labyrinthine path through the alleyways in Zanzibar's Stone Town, scarcely taking the route I had planned out from looking at the map.  Did I reach my desired destination?  Well, kind of.  What I anticipated using as clear landmarks weren't what later became part of the constellation of cues that I used to navigate my way throughout my time there.  It's okay that this happened, of course, but having your plan not be as useful as hoped can be unsettling in the moment.  Depending on the situation, different types of finesse seem to be needed to redirect that discomfort of being a bit lost into adjusting so you can learn what you need to know.  For the alleys in Zanzibar, that meant learning which Swahili style doors, which facades of concrete with worn away paint, and often which smells to register to indicate where I was; those alleys didn't have names and were pitifully represented on a map (as I had discovered).  I have been reflecting on the adjustments I've made throughout the various settings I've been in these past few years, landing me here in Lilongwe now.  I think a better translation for the saying would call for swapping the definite article "the" for the indefinite "a" so it reads, "to lose a way is to know a way."  Swahili doesn't generally use in/definite articles the same way English does, so I think my translation still holds water with the linguistically-inclined crowds.

Anyway, what am I up to here in Lilongwe?  I'm working on a research study this summer with the University of North Carolina's Project Malawi, a clinical and research site that has been here for about two decades.  I'll be here until late July, will swing up to Tanzania for a quick visit, then will get to enjoy a bit of the Maine summer weather before heading back to NC for 2nd year med school classes to start. This summer is certainly not in the running for my summer with the most down time, but I've enjoyed things so far and am looking forward to the next 7ish weeks.
 I'll write again soon, I need to go check on my kilo of ginger that I'm attempting to crystallize... and wash my hands, because the ginger juice from peeling & slicing said kilo is burning every finger microabrasion that I apparently have.  Hope you're all doing well.

One picture for the road: the outdoor sitting area at the UNC guest house