[Photo: Malachite kingfisher, building a dwelling in the mud bank. Liwonde National Park, Malawi]
15 February 2017
I feel so fortunate in many ways. I do have a litany of misery I could recite but I am astounded to be able to do what I do at 76yo. Teach, give, hike, bike, love, write. Argue, hate. Even 10 years ago 2020 seemed very distant. I thought, “I’ll be 80yo and the game will be up. “ I think not. I plan to go until 2056 so I can wear out the ostrich skin belt I bought at the Indian Spice Market in Durban. I’ll be 116yo.
As I was biking around trying to do errands and get the electricity fixed—a bad main breaker switch goes off 4x/day on average, turning off the fridge for the weekend if we go away—I happened on the Blantyre Power Station. ESCOM, the Electrical Supply Company of Malawi, Ltd., has the motto on their trucks: “Toward Electricity All Day, Every Day”. Before you burst out laughing, as I did, if you realize that this is one of 3 poorest countries in the world, it’s pretty amazing to aim for that. Of course, their logo says, “United We Stand; Solidality Forever”. At least it didn’t say, “Untied We Stand…”. “R’s” and “L’s” are fairly interchangeable here, so it isn’t as outlandish as it may seem.
I rode up to the hospital yesterday and saw a woman crawling on her hands and knees, pretty rapidly, toward the AETC (Adult Emergency and Trauma Center). I was a bit perplexed that if she was too ill to walk, how could she speed along so well on all 4’s? I mentioned this to the nurses and one of them wondered if she were paying some sort of religious penance. I suppose it would really change your perspective if you went around on all 4’s; you might feel you’d done adequate penance.
I saw a child last week in Peds Psych Clinic, Scoffa. He is 12yo and is dying of HIV/AIDS. The last two times I saw him he was delirious, skeletal, eyes like a Keane painting, crying unintelligibly, undressing, running around in the room, and slapping the desk really hard with his open hand. He is an inpatient and has come to see me from the Peds Ward. I was packing up to leave as the morning rush was over and he hadn’t come. I assumed he had died. But I looked outside a few minutes later and there he was with his mom. I hardly recognized him. He’d put on a little weight in a week, was calm, and looked me in the face and said, “I feel just fine now.” Antiretrovirals are amazing! It was truly unbelievable.
I saw another child in consultation in the Peds Special Care Unit. He had been found in a bush outside a local town and taken to the police who brought him to Queens. He was mute and appeared to be about 6yo. He looked terrified and with good reason: his anus was dilated and lacerated, suggesting he had been raped. He also had a fecal impaction and when he was anesthetized and disimpacted, they found dirt and sand mixed with feces. It is unclear if he was eating them or how they got there. In any case, they had paired him with an ample, warm, maternal woman who would be with him during his stay as a surrogate mom. She had managed to get out of him that his name was Atapa. But nothing more. He didn’t look learning disabled, just traumatized. He was treated for presumptive STD’s and given HIV post-exposure prophylaxis. He was eating well. When I went to see him with the medical students a few days later he had been discharged to an orphanage in the town where he was discovered. Maybe parents can be found. Was he kidnapped? Was he abandoned by his relatives? Happily, the guardian with him as an inpatient will continue to be with him for the foreseeable future. Some continuity of attachment, however slight.
At our department meeting today we made plans to go 5 hours north and east, towards the Mozambique border, to visit two villages and a school. Many children from those two villages are participating in mass hysteria and the school and district health office want some help to decode and stop it. We’ll all go: Stefan the Director, myself, Chiwoze the only Malawian PhD Psychologist, and Mzati who is a journalist turned sociologist. We’ll have to spend the night in Mangochi, which is crocodile and malaria central. Plus, hot as Hades and subject to water and electrical cutoffs regularly, making emergency surgery at the district hospital at night, for example, pretty dicey. More about this after the trip.
We plan to move in ten days to our new digs. I went there today to lock up after the carpenters had put up the window screens. It is cute but tiny compared with here. I hope we don’t get underneath each other’s feet. It has a huge, lovely yard where we can sit. And I got an estimate from the carpenter for a thatched-roof shelter off the kitchen—about $65 which we can afford. Since it is always t-shirt weather here, it’ll be like another room. We may build an open-sided rondavel, a round, thatched-roof hut where we can put a table and chairs to be outside. I need shade and to use plenty of SP 45 sunscreen in this climate with my Scot-English skin.
Speaking of Scots, Burns Night (in honor of Robert Burns) was a hoot. Lots of men in kilts with dirks and sporran. The mistress of ceremonies, a very pretty, tall, young, willowy Scot (dentist), danced enthusiastically with her be-kilted Malawian boyfriend who is fully a foot shorter but very lively. Some humor roasting the opposite sex. “The quickest way to a man’s heart? A long, sharp blade through the chest.” And, “The bank robber had the teller fill his sack with money, then said, ‘You’ve seen my face’. and shot her dead. He wheeled around and saw a customer, mouth agape, staring at him. “You did, too”. and shot him. “Did anyone else see my face?”, he demanded. An elderly lady looking at the floor softly said, “I think my husband may have caught a glance.” Then there were toasts to the haggis and we got sweaty doing Scot line dances. Very fun and silly.
We are taking Chichewa lessons and for some reason—lazy, busy—I haven’t been studying. I am the dunce in the class and it gives me new sympathy for dunces. Dreading the teacher calling on you, feeling shame that you are such a loser, even concerned you are embarrassing your significant other. They haven’t given me the tall, pointy hat and sat me in front of the class yet but they well might have. I’d add, in my defense, that, except for Linda, they all have brains the age of my grandchildren (if I had any). Sponges. Mine is more like—-a stone?
We spent this weekend with friends at Lengwe National Park in southern Malawi. The park hasn’t been managed well and all the large, edible animals have been poached. The trip was arranged through the Wildlife Society of Malawi, of which we are now members. The centerpiece of the trip was a 3 hour airboat (Think of a huge, noisy engine with a massive fan attached to the back of a 20’ long flat-bottomed skiff carrying 8 people that can plane over tussocks and floating islands of greenery.) ride into Elephant Marsh. The latter is 150-450 square miles of swamp, depending on the flood stages of the two rivers feeding it, discovered by the missionary David Livingstone in 1859 as he was ascending the Shire River from the Zambezi. He sighted 800 elephants. None are there now, although there are some hippos, alligators, and a magnificent array of birds. After an hour or two I wished I was paddling quietly in a kayak or a canoe because of the noise. We saw a spectacular number of gorgeous birds, however. We then spent the afternoon cooling off in the pool at the lodge, eating braai (barbeque), and playing a British board game called “Brandi Dog”. I do long for an Anchor Steam beer or some beer with a bit of a bite; Carlsberg Green is pretty blah.
I wrote earlier about a case of Donkin Psychosis, a post-partum psychosis associated with pre-eclampsia and which is cured rapidly with antihypertensive medication. The world authority is a Brit with whom I’ve been put in touch. He was very excited to hear of this case, as none have been reported from Africa. I think I’ll write a brief single case report of it for publication. To do so I must locate the medical records. I went to the gynecology ward two days ago where I was directed to their record storage room. 4 desks, 4 employees at the desks, loud Afropop on the radio, and zillions of 10 inch high bundles of loose paper records tied with string. And floor to ceiling cubby holes running the length of one wall filled with similar bundles. As luck would have it, filing was about a month behind and as three of us began to sort through 3 stacks I quickly found the record of her recent admission. I could not believe it! So I removed it briefly and made copies. This week I’ll try to find her perinatal record documenting the details of her labor and delivery. Knowing how inadequately documented the records are, I may have to go to her village with an interpreter and interview her and her family. All in the interest of disseminating information to improve medical care. I know I would have begun her on an antipsychotic and been amazed at how quickly it worked to reverse her psychosis—-when in fact it would have been irrelevant to her care. The antihypertensives were all that were needed.
This is a scattered note, I realize, reflecting my mind at the moment. I’m going to study Chichewa for at least an hour today. And finish up a lot of other stuff. We returned from Lengwe this morning by minibus as our friends had a village obligation in a different direction. It was a comfortable, not terrifying, ride costing $1.30 each for the long journey up the escarpment from Chikwawa to Blantyre. On our walk home from the minibus stop we were happily surprised to see that one of the footbridges we use to access a path through the cornfields to our house had been repaired and was being painted robin’s-egg blue. Previously one had to cling to a railing with both hands and scuttle, crab-wise across on a stringer, as there was no floor. Today we strode across, saying, “Chabwino!” (Pretty) and “Zikomo” (Thank you) to the 4 workers. Progress in Malawi!
A psychiatrist in Malawi 