[Photo: Self-explanatory]
2.4.2017
We are neither of us big drinkers. I bought a case of beer mid-January in anticipation of Pat and Stacy coming for 3 weeks. We are down to the last beer and expecting guests for lunch today so yesterday I decided to bike to Shoprite, the closest thing to a normal US-style grocery store in Blantyre. Nothing, of course, compares with either of the two Berkeley Bowl stores which are unique in the US. Certainly Whole (Pay Check) Foods doesn’t reach the rarified foodie standards of the BB, with 16 varieties of fresh mushrooms! So I set out on my bike, raced the couple of miles and up the fairly long second hill nearly to Shoprite when I suddenly realized I had forgotten to bring the case of empties. I returned home, feeling dumb, strapped on the case and off I went. Traversing the crosswalk about halfway there my bike skidded and suddenly tipped over. My front tire was completely flat. So I pushed it back home, past the market where I regularly buy bananas and the occasional tomato, past George who sells me AirTel top-ups for my phone from his broken red plastic table with the faded AirTel umbrella, down the path and then down the dirt road to our gate. Once inside I took off the case of empties, removed the front wheel and the inner tube, found the leak, patched it, reassembled the tube and tire, pumped it up and reinstalled it. I even tightened my front brakes, which were very spongy. Then I again strapped on the case of empties with bungie cords and set off for Shoprite. Street children blocked my way as I turned into the parking lot, asking for “A dolla, boss.”. An (inebriated) man wanted to discuss the logistics of carrying 24 bottles of beer home on a bike rack. “It would be better if you just drank it here. Then you could give me one.” At last, I exchanged the empties for a full case, loaded up, and made it home without incident. Persistence, that’s how you get Carlsberg Green home on a bicycle. It does make the bike pretty top-heavy.
I visited the young man with epilepsy who fell into a fire during a seizure and burned his arm so badly it required amputation above the elbow. His mother was feeding him and he looked pretty cheerful, if anxious, when I saw him. Since they speak Sena, not Chichewa, I had to locate an intern from another part of the hospital to interpret for me. Is he having seizures in the hospital? “About one a week.” I checked his chart and he hasn’t been started on the Na Valproate I suggested 1 ½ months ago. Why not? “We don’t have it”. It is ironic, since he is here because he has an uncontrolled seizure disorder that led to very extensive injury and medical care and he isn’t being treated for the epilepsy. In fact, until he came to the hospital he has been “treating” it with herbs from the traditional healer in their village. They live far to the south and in a village far back on a mud track from any medical care. I returned the next day with a sack full of phenobarbital and a three month supply of Na Valproate, both with directions. His mother assured me they could get to the district clinic every 3 months to refill his meds. I would have been arrested and lost my license in the US if I dispensed medications, especially a controlled substance, directly to a patient in a hospital bed. However, it seems like the best likelihood for him to take them.
I’ve been seeing a 13yo boy in 25 minute weekly psychotherapy visits for several months per his parents’ request. He is very bright and a talented athlete, according to his school, but doesn’t apply himself. His parents are hard-working, caring people. Seeing him has perplexed me, as he is unfailingly polite, proper in his school uniform, guarded, and humorless. He has seemed terribly inhibited and I couldn’t figure out why. Was he beginning to learn about his own sexuality and it frightened him? I was not about to bring that up for fear of spooking him. Well, last week and this he began to talk. First about rugby, at which he excels and which he loves (Judging from his father’s size, he’ll be an All-Star!) and, then about his 3 year old younger brother. He can’t stand the way Jim, let’s call him, always wants to play outside. Our talk quickly led to what it was like when Jim first joined the family. “When he was born and came home from the hospital I thought, ‘OK, he can be here for a week or two but why is he staying?’ I hated him so much.” We have more to explore but I think he’s offered a clue as to at least one reason why he curbs his aggression so violently. The irony is that a week ago I was about to suggest we take a break, as the silence in the sessions seemed so painful for him and was so tedious for me. We tried some games but he approached them in the same way, lackluster and seemingly intent upon losing to me. My pointing that out went nowhere. How can you lose at Battleship?! HIs dissatisfaction with the current state of therapy must have echoed my own. Or, more likely, he finally felt safe enough to begin to access his feelings. Wonders of unconscious communication! I feel like we’re moving in a direction that may be helpful to him.
I think the most important and lasting, for me, aspect of this whole experience in Malawi, and with Linda, is how much I am learning about myself. There is nothing like moving outside your comfort zone in intimate relationships and challenging settings to offer new perspectives on oneself. And when they ring true, accompanied by all the requisite shame and guilt, it is like striking gold. Sometimes like striking a gold crown on your tooth!
Tomorrow I’m off by minibus to Mdala, a small village in Chileka, a nearby district. I’ll take my trusty sidekick and interpreter, Maurice Chipwete, who is a truly fine person. We will seek the Health Surveillance Assistant supervisor at the District Health Center who can hopefully direct us to find the lady I want to interview about her pre-eclampsia puerperal psychosis (Donkin Psychosis) which I have mentioned in an earlier post. I’m taking her a bar of soap, a package of tea biscuits, and a liter of cooking oil as a gift/bribe for the interview. I hope she’ll cooperate so it can be a gift as bribing a very poor person to do something they don’t want to do feels, and is, exploitative. Yet I want to publish this paper because it can help others with a similar condition get appropriate treatment. And it has never previously been reported from Africa. More later.
We have bougainvillea growing as a tree, about 10 feet tall with a thick trunk and tendrils like a fountain of fuchsia blossoms. The cosmos are brilliant orange in tall, deep banks; apparently when they finish we’re to shake the heads and they re-seed for the next season. It is difficult to think that mango season is 8 months off!
A psychiatrist in Malawi 