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.