The last night at the Bridgeview Hotel was not great. We both slept poorly. A mosquito was whining around and when I tried to shut the window it stuck and then slammed with a loud “crack”, awakening Linda. The mattress had been feeling very hard for the previous couple of nights. A regular PC volunteer (he’s recovering from pneumonia) mentioned yesterday that he moved to the Korea Garden Hotel because his bed here had no mattress. Eureka! We checked and, sure enough, we were sleeping on the bottom side of a box spring, slats and springs and all. No wonder my shoulder was so sore when I slept on my side! So, we asked them to put a screen in the window and a mattress on the bed; I suspect they have too few of each and rotate them from room to room until the next person complains. We are sure we had a mattress for the first week or two. My side of the bed then smelled foul, like sweat and urine, and I couldn’t imagine that came from me. I checked carefully and the mattress was scented with another’s perfume. Let’s get out of here.
Writing this in the lobby so as to get internet, I heard “George?”. There was a young man, my height (short), with a buzz-cut and a very engaging smile shaking my hand. This was Stefan, my counterpart and boss, the only psychiatrist in Malawi and the Director of the Department of Mental Health at the College of Medicine. He is bright, warm, flexible, hard-working, and very friendly. He’ll become a good friend, as well as a partner in crime, as we plan together how to improve the provision of mental health services in Malawi.
As far as he knows, there is only one Malawian psychiatrist in the world. (Two are currently in training!) That one previously ran the country’s primary mental hospital (250 beds) at Zomba, of which you’ll hear more when I work there. But he decamped for Manchester, England. So our work with the advanced medical students and three psychiatry residents will be important. The lecturers and mentors will include the two of us, as well as a cadre of visiting psychiatrists from Scotland who come for a few months throughout the year, often returning the following. I’ll expand my repertoire to teach Old Age and Addictions and have some ideas about each of them. The students apparently love to role-play and the curriculum is being altered so that it is more interactive and less lecture-based. The students are supervised seeing patients in the clinic at Queen Elizabeth Hospital (“Queenie”) in Blantyre and they work with inpatients at Zomba during their 6 week psychiatry rotation. If this description is confusing to you, imagine what I feel!
Stefan asked me to accompany him to Kamuzu Central Hospital where we saw a government figure who was having a hypomanic episode, complete with sleeplessness, limitless energy, and paranoia. Luckily, he was with his wife and child and they helped him to listen and agree to a trial of medication (which has helped him in the past). Cultural differences aside, Stefan sees eating disorders, anxiety disorders including PTSD, depression, bipolar disorder, and schizophrenia, a similar spectrum to American or European mental illness.
In any case, this promises to engage me and stretch me and be a lot of fun, especially with such an ally. He and I snuck out for a couple of beers that evening and talked about ourselves and our lives/hopes. He’s Austrian, raised and schooled in Vienna, and did his psychiatry training in the UK. His partner Lucy, whom I haven’t met, is a journalist who worked in Egypt setting up Al Jazeera.
Two days later we were sworn in at the Ambassador, Virginia Palmer’s, residence. It is a lovely sprawling home set on acres of gardens with a swimming pool and a 9 foot Steinway in the living room. Speakers included two among the GHSP volunteers, in English and in Chichewa, the Peace Corps Country Director Carol Spahn, the Ambassador, and the Minister of Health. It was very moving to hear Peace Corps (accurately, I think) described as one of America’s best foreign policy initiatives, now 55 years old. Then wonderful snacks and a cake and talk and we left to change and pack and drive to our sites. We have now bonded and left others several times: our wonderful faculty and the Liberia and Swaziland volunteers in DC, the Uganda and Tanzanian volunteers at the airport in Addis, and now we Malawi volunteers are scattering to 4 different cities: Mazuzu (think “coffee”), Lilongwe (the capitol), Mangochi (near the lake, hot, mosquitoes and alligators), and Blantyre (center of commerce). I feel a twinge of sadness at the separations.
The bus carried us for 5 hours through the Malawian countryside, which is dotted with beobab trees, huge termite mounds, the ever-present mud-brick kilns (a huge loaf of bricks with openings underneath in which to set and stoke fires), little villages of mud-brick huts with thatched roofs, and the strikingly steep mountains that jut up from the plain here and there. Occasionally we’d drive through one-street towns with shops—Howarth’s Panel Banger (ie, body shop)— and the ubiquitous open markets selling everything from gorgeous fruits and vegetables to tires, sacks of terrazzo grit, bales of used clothing being prepared for sale, and the famous Malawian delicacy, mice on a stick. So, a curved stick about 3 feet long has perhaps 10 mice skewered on it and then the entirety is roasted. I haven’t tried them yet. The seller stands by the road holding up his stick(s) like a phallus, seeking a sale. The bus carried all the luggage, 3 volunteers, and 3 faculty from the College of Nursing. We stopped in towns for the faculty to bargain for vegetables and fruit, considerably cheaper there than at home. On both stops the bus was surrounded 3 deep by merchants selling chips, peanuts, cabbages, eggplants, cold drinks, and so forth.
Peace Corps is scrupulous about our safety and forbids driving between towns after dark. Just as darkness fell, we entered Blantyre, a hilly city with many trees and handsome houses behind tall brick fences topped with glass shards and/or barbed wire, each with a guard in front. In the dark we drove past Queen Elizabeth Hospital (1000 beds, old, one story) and turned down a quiet dirt road to discover our new homes for a year. We unloaded, looked around inside, had a beer, and fell asleep.
The house looks like a 50’s ranch, brick with a long covered porch in front with a sloping lawn. The house sits on about ¾ of an acre and has views over the city and of a sharp, tall mountain. The rooms are large, with three bedrooms, 2 ½ baths, a kitchen, dining room, and large living room with a—-fireplace? This is winter and I’m comfortable in a tee shirt. In back is a patio with laundry lines and another smaller house for the help. So far the house comes with a guard and a gardener. We’ll likely have someone to clean, do laundry and cook a couple of suppers a week. Help is about $50/month. Overpaying them throws the system out of whack, incites jealously, and confuses people. Did the colonialists say the same thing? It does feel strange. Being a guard means sitting about all day (and night) by the front gate, walking the property occasionally. The property is fenced and the house has bars on all the windows, separate barred doors, keys and locks to everything, and, now, a mosquito net over our bed. The yard has guava, avocado, and frangipani trees, as well as a variety of others I cannot name.
There is a sweet open market with numerous stalls 5 minutes up the street where we can buy vegetables and fruits. We had delicious chips (French fries) in a little plastic sack with salt, vinegar, and hot chile, all for 55 cents. So delicious I think I may go for some now! Work begins Monday, when I’ll meet Stefan in clinic. The students are on break until 22 August.
I am reflecting on the aphorism, “You only begin to really live when you get out of your comfort zone.” Definitely getting out of there pretty quickly!
A psychiatrist in Malawi 