[Photo: Peter, Caroline, Linda, George and Hut Keeper at Chinzama Hut, Mt. Mulanje]
18 April 2017
Our academic cistern is nearly drained. The last rotation of 21 4th year medical students is ending; lectures are completed, problem-based learning exercises almost finished, the final rotation for the year of Scots to help us teach has arrived, and there is only one day left to supervise the students evaluating patients in clinic. Remaining are oral case presentations, 3 minute video clips of their patient interviews, a practice quiz, reviewing their long case write-ups, the 3 hour written examination, the oral exams, and, finally, their feedback to us. Yesterday was the next to last day of their small group presentations of learning objectives from PBL #5. One group did a quiz show live; the other performed music, complete with keyboard, guitar, dance moves and singing—-“Effavirenz, oh, oh; depression, malaise, oh, oh”—the side effects of the antiretrovirals (ARVs) used to treat HIV. It was hilarious and instructive, especially to see them all shaking their booties and loosening up. Plus, we learned, again, about the various ways HIV devastates a person.
I took two medical students with me a week ago to do a consultation in the Pediatric HDU (ICU). A 6 month old girl came to the hospital with diarrhea and weight loss. She was found to have AIDS and started on ARVs but continued to deteriorate, going from 4kg to 3 kg in two weeks. Her mother was exhausted and tearful, by her bedside day and night with no family relief or support. The students interviewed her for an hour. We then enquired of the baby’s condition from the pediatricians as we left the ward and were assured that she was “doing OK”, despite the continued weight loss. When I returned to see the mother yesterday, the Registrar told me the baby died two days after our visit. Death stalks the halls at Queen Elisabeth Central Hospital. I told the medical students and they looked somber. Death in hospital is so common here; I don’t know if it is the rule, rather than the exception, but patients are so ill and resources to help them are so limited.
Easter weekend was a 4 day holiday so we planned a hiking/camping trip to Mulanje. We went with our friends, Peter and Caroline, who are from Zimbabwe but, after 40 years in UK, couldn’t get a permanent passport to return, being white. Robert Mugabe somehow keeps oppressing and stealing. Only the good die young, as the lyrics go. We four, plus guide Samson and 3 porters to carry our large packs, ascended, leaving a farm cooperative 180 degrees across the massif from our first trip up, walking through lush fields of sweet potato, maize, and sorghum. Women wearing colorful chithenjes worked in the rows, singing together as the irrigation ditch delivered water to the rich, red-brown soil. A group of young girls followed us for a distance; they were delighted when we photographed them and showed them our snaps on the little LED screens.
We took about 5 ½ hours to hike the 3000 foot climb to Thuchila Hut. It is a wonderful 4 room cedar cabin built over a hundred years ago, with views over the edge of the escarpment and up to the peaks on 3 sides. Instead of a meditative silence, however, we found 9 children and 5 adults (two more women came after dark). It was fun to see the kids absorbed in their play, whether exploring or playing UNO, and interesting to meet the adults, all of whom have their stories.
By morning we were ready for tranquility, however, and set off at 7:50AM to get to Chinzama Hut, which we loved when we stayed there in September. We dodged the rain, established our pace and rhythm, took photos, and marveled at how incredibly fortunate we were to have the time, resources, bodies, and desire to immerse ourselves in such beauty. Instead of the brown of the dry season, everything was green, except the flowers which included a variety of orchids, coreopsis, impatiens, straw flowers, and hot pokers, all a cornucopia of colors. We passed through a small rain forest in one valley—moss, giant ferns, huge trees all dripping wet in the sun.
Linda was our chef de cuisine and had prepared intensively beforehand. We ate like kings and queens, a newly-baked bread with each meal, omelettes with cheese, fresh basil and a side of home-made chorizo, fresh salads from our garden, and on and on. And endless cups of tea. The four of us got on like duck soup (perhaps the only dish we didn’t sample). We each did what we wanted on the trip.
While Linda and the Finches, with Samson, headed off for a several hour hike (and a drenching), I read Somerset Maugham’s The Moon and Sixpence about Paul Gaugin, while I sat in a wicker chair overlooking peaks and valleys. I’d forgotten what a craftsman Maugham was. And what an aesthete! Anyway it was a slim volume to carry, printed in 1935, selling then for 35 cents, and falling apart. As clouds and fog rose, I saw a wonderful photo op, so I scaled a 30 foot boulder and got my pics. It began to rain lightly but promised a downpour so I quickly decided to descend. Unfortunately, I had pulled and scrambled my way up and found it quite daunting to go the other way. I called to one of our porters, Bison, he who won the 25Km Porter’s Race up, across, and down Mulanje 3 years in a row, to rescue me. He came and provided reassurance which allowed me to get down without injury. Then the heavens dumped buckets which I could watch from the dry shelter of our porch.
The days passed so easily and the warm fires at night with whiskey-infused hot cocoa before bed took off the wet mountain chill. On our return to Thuchila we had the hut to ourselves, played Pounce and Brandi Dog (a British board game), and got to know each other more deeply as the rains poured.
Our descent on Monday was treacherous. Streams to cross were very full, rocks wet and slippery, and the trail very steep for a very long time. Three of us fell, a few several times, slipping in the clay turned —sic—to “slip” by the prior rain. We stayed dry, stopping for the scenery and to rest at perfect viewpoints. We watched three women carrying 15’ long bundles of sticks for firewood, gliding down the mountain in their bare feet. When they paused, I attempted to lift one of the bundles which was propped against a tree. As I approached it with my arms open, its owner jumped back with an amused smile on her face, thinking I was going to hug her. We laughed together when I showed her how I just wanted to measure the weight of her load; I couldn’t budge it off the ground. Such deluded, frail creatures are we. I’d felt so strong hiking for the four days but couldn’t match this {probable} mother of 6 in her early 40’s!
We drove on the muddy, potholed road back to the town of Mulanje, where we each ordered and devoured a pizza and a Carlsberg Green at Mulanje Pepper. The pizza isn’t the Cheeseboard or Zachary’s in Berkeley, but tasted every bit as good. It’s all perspective, where you are standing at the moment.
I’m off to our weekly clinic meeting, then to town to pay for the internet which was shut off last night for non-payment, and to shop for vegetables and fruit at the closest open market. Stupidly I used Linda’s bike lock to secure our bikes and she is in Lilongwe for a meeting for several days with the key. So I have to hoof it and, believe me, the old bike saves a lot of time!
A psychiatrist in Malawi 