We just finished the first week of teaching, a week of Child and Adolescent Psychiatry for half of the 4th year class at the College of Medicine. My co-teachers were Heather Gardiner, a child and adolescent psychiatrist from Scotland (now living with her husband, a professor of forestry, in an old limestone pile on a hill outside of Bordeaux) and Kathleen MacKay, also a Scot from outside Aberdeen, who has specialized in the Developmentally Disabled (mentally retarded, intellectually disabled, developmentally delayed. It’s like being half asleep, lying on a piece of grit and rolling about fitfully trying to get away from it. There is no easy way.). Both have been here before, for two week blocks of teaching, and both are delightful and thoughtful women.
The students, all 42 of them, were bright, fun, hard-working, and engaged. If the other half of the class, whom we teach in the Spring, are similar, this will be a great year. It is pretty bleak after graduation and internship for medical students as the government doesn’t, but should, fast-track them into jobs or residency training programs, of which there are several here, including General Psychiatry. So some get jobs, some languish, some go to Lesotho or Zambia or elsewhere to work, although they want to be at home in Malawi. It is incredible how things work (or don’t) here, like medication procurement. It directly affects patient care in the worst way and there is no good, logical reason it should be so dysfunctionally bureaucratic. But it is. A bit like doing jazzercise in a swimming pool of warm molasses. I must be ready for breakfast! I’ll have more about the teaching and students as the year progresses. They are a high point and to watch them roleplay an interview with a patient is hilarious when they are trying to demonstrate bad technique—-finger pointing, talking on the phone, firing questions, groaning loudly, “That’s horrible.”, and so forth. Excellent dramaturgy.
We visited a large home/program for street kids, Samaritans. It is run on a shoestring and provides the children with safety, food, clothing and shelter, basic education to prep them to go to the neighborhood public school, vocational training, and, crucially, caring relationships with good boundaries. The kids, as everywhere, were open and fun to interact with and the students got a real kick out of eliciting their stories. Three girls were there from Zambia. Their mother died in childbirth with the youngest girl, at which point the mother’s relatives stole all the family belongings and threw the children out on the street. With their father and paternal grandmother they slipped over the border into Malawi, lord knows why. Their father ran off, not to be seen again, clearly overwhelmed. Grandmother was alcoholic and smoked chamba (marijuana) and when they confronted her, she beat them. So they ran away. Samaritans sweeps Blantyre twice per week for street children and picked them up. They are 13, 11, and 7yo, bright and cute and very happy to be in a safe, caring place. There are goats and pigs, and a garden of vegetables in the compound.
Samaritans is looking for a new vocational project—somehow the bicycle repair ran its course, although the bricklaying continues. I shall apply for a small Peace Corps Grant to bring in a young volunteer, Anya, who is teaching villagers how to make briquettes from a slurry of leaves, cardboard, and rice hulls, all of which are plentiful. They are put through a simple press, built by a local carpenter for about $20, and dry for a few days. 5-7 suffice to cook a meal, saving trees and the labor of gathering the increasingly scarce wood that is available. A teenager can make 30 briquettes per hour, so with a few machines they could have quite the factory. The director of vocational training was thrilled when I suggested it to him. A psychoanalyst and child/adolescent psychiatrist’s scope of practice is pretty wide here.
Lying in bed under the white mosquito net, with my eyes half closed, is like going through the fog on Penobscot Bay, travelling from our island to the mainland. We take turns getting tea and the one up first wraps the bottom of the net and tosses it onto the ceiling of the net, creating a lovely white cloud floating over the bed. Small pleasures.
I am astounded at the resiliency and ingenuity of Malawian villagers. They have little or nothing to eat much of the year, no bank account or steady job for income, few clothes or possessions, and extremely simple dwellings. They are subject to everything from puff adders and mambas to malaria (It is all falciparum here, the bad kind that kills you with cerebral malaria and/or Blackwater Fever.) to you-name-it parasites, and on and on. Smiling, sitting in the dirt all day, colorful stacks of tomatoes and cucumbers and eggplantsbefore them (all of which they have grown and carried to market), a baby strapped to their backs with a beautiful chitenje, gracious in bargaining, curious, and friendly. Certainly it makes me think about what I get irritated by and how petty most of it is. And given the primitive level of health care available to all of them—-The Clinical Officer in each district health center is basically a Physician’s Assistant who makes complex diagnoses, prescribes medications, and does surgery,. He/she will see 300 patients in a day— they seem impossible to kill! Clearly they were the beginning of us all, as the Leakey’s determined and as their continuing vitality suggests.
I’m reading The Doctor Stories by William Carlos Williams. His description of ol’ Doc Rivers puts me in mind of this place. Williams’ poetic sensibility and humanity and practicality is the perfect antidote to the despair you can feel here if you allow yourself to slide.
A psychiatrist in Malawi 