A Consultation

[Photo:  Competition in primary care medicine is fierce in Lilongwe and the practitioners have expanded their skill sets.  ]

4 June 2017

I met Chisangalalo Ntonio several months ago and he expressed an interest in my working with his teachers and child care workers. He is the Director of Education for a large (thousands of children served in numerous locations) child care organization in south central Malawi. His father was the first Executive Director of the organization, an NGO funded by a pastor in the UK and his wife. Finally, after a lunch together and several starts and stops on my part because of schedule conflicts, three 3rd year Family Medicine Registrars (Residents) and I met at 8:15AM Friday morning at the entrance gate to the College of Medicine where Chisangalalo was to pick us up. In my experience, getting these consultations going can be a challenge; everyone is stretched too thin. Anyway, by 8:45 I called him; he’d forgotten it was Friday and set out from Lunzu to get us (45-50 minutes away).

Boring details aside, he arrived, apologized and drove us up the Chileka Road through Lunzu, then down a several kilometer dirt track until we reached Aquaids, his organization.  It occupies a large parcel of very rural land, occupied by many buildings—-schools (primary and secondary schools, a school for the developmentally delayed, and so forth), administration buildings, lodgings, kitchens, a methane digester for fuel, etc. Who knew?! And lots and lots of kids.

After a brief meeting with the current Executive Director and a tour of the facilities, I was led into a large hall occupied by 25+ women sitting in a semi-circle facing the front of the room—and me. I didn’t realize that this would be a working visit, thinking it was more of an introduction. So I just winged it.  Seeing the Registrars shake each woman’s hand in turn, I followed suit. Then one of the Registrars said a prayer to open the meeting and we introduced ourselves. Meanwhile I’m scrambling a bit inside myself, thinking how to make this useful to them.

When all turned to me, I asked them to think of the names of a few children about whose behavior they were concerned. Quickly a list of 8 was assembled. We began with one, Jones, an 8yo boy who had pooped in a pot, then cooked it and tried to get younger kids to eat it. He’d also snatched the vice-principal’s solar charger and tossed it into the pit toilet (Ten feet to the surface, then probably another 10 feet of urine and feces to the bottom where it now lies.). And other endearing acts. Was there anything to love about him? Silence. Then, he could be affectionate and if you asked him to perform a task he usually did it very well. Any family history? His parents both died of HIV when he was two and he was raised by his older sister. He is a twin, a runt compared with his twin sister, both of them being HIV positive and taking antiretrovirals. He is still repeating 1st grade, whereas his sister has moved on to 3rd. OK, something to help us understand his behavior, I thought. Bring him on.

In came a tiny, frightened-looking boy. I asked him questions like, What was his favorite food? Rice. His favorite drink? Orange Fanta. I asked him to draw a picture of a boy. He scrawled a circle for a head. I applauded him. I then asked him to take my pen to one of the women in the audience. Which he did and we again applauded him. Fortuitously, someone brought in soft drinks for us all and I requested an orange Fanta for him. He was very pleased and slugged it down in record time. We applauded him again. He was very cute and clearly capable of affectionate, as well as angry, attachment. We thanked him, sent him out to rejoin his friends, and I led a discussion.

What had we seen?  How to explain his naughty, angry acts? The poop soup I dismissed as a variation on children’s scientific researches, sidestepping the hostility involved. So why was he so difficult in class? a teacher asked.  Why do children behave in class? I countered.  They want to please their teacher, for their teacher’s love and approval. As an extension of wanting to earn their parents’ love and approval. But this little boy hadn’t received mother-love, which all the teachers and workers could understand. I spoke of the hint of wild animal I saw in his eyes as he sat with me. Like the impala who is terribly thirsty and comes upon a water hole but is terrified, having previously seen a crocodile emerge from the same to eat his cousin. For Jones, the fear was desperately wanting love and being terrified he’d open himself to it and be wounded, if not consumed.  All of this was pretty simple and straightforward but a voice from outside saying it to a group of overworked, undertrained educators and child care staff seemed to arouse enthusiasm and a sense of recognition. Jones needed a lot of love, especially physical affection, and praise. He might not change rapidly, but those seemed to be necessary ingredients for him to want to behave better and to feel better inside himself. I subsequently realized that it might  be helpful to have one of the workers take him under her wing and let him help her cook meals, since he has a cooking bent. I’ll pass it on.

There was then a closing prayer and we left, driven back to Blantyre by Chisangalalo. On the dirt road from the Center, we passed a few huts. A drunken man, the Village Headman it turned out, hailed us. We stopped, he climbed in the back of the truck as all seats inside were taken, rode about 50 meters and asked to be let out by another cluster of huts. Exercising his power, I guess.

The visit to the center had been a moving experience for me and I instantly fell in love with the place, the children, and the workers and committed to visiting every two weeks. I justify the time to myself, since my task in Malawi is teaching, not providing clinical services, in that I shall be teaching, just not in a degree program like at the College of Medicine. It is so easy to take on too much here.

I leave for the US in 3 ½ weeks and I’m getting excited. The stresses here are cumulative. Water cut-offs for part of the past two days—-didn’t The Water Board know we had a dinner party last night? My bicycle is not shifting worth a damn and needing both front and rear derailleurs to be dissembled and cleaned, which I suppose I can do but don’t want to take the time. Nor do I have the tools, like a seal pick. Once again after payday one of our guards fails to show up, so when he does I must let him know he cannot expect to keep his job behaving like that. And docking him pay for the absent day. I can get most of what I want here most of the time, in terms of books, tools or food. Linda attends to the latter for us very well. However, I often have to travel far and wide to find what I want and often it is to no avail. I need a large mortar and pestle to macerate the paper and leaves we are soaking to make cooking briquettes. I have regularly seen them in the Blantyre Central Market. But not yesterday. In Kamba Market? Nope.  Maybe in the market in Zingwangwe. So I rode there and hiked through the market but no luck. Not sure why I am whining so much. Each little search is fun in its own way. I haven’t shaken my cold yet and I don’t sleep well when stuffed up.  I miss contact with my kids. I miss the relative ease of living in the US. I am longing to sit on the front porch at Beach Island with coffee and a book, as the sun rises and warms me.

We are going to take a walk. Before we go, Linda is making us some chai tea. Maybe my mood, and attitude, will improve.

One thought on “A Consultation

  1. As you wrote I was spending the week on Deer Isle–cold, wet, foggy. To top it all off there was a lightening storm in the middle of the night with a very loud crash–once I had crawled out from under the covers, determined I was still alive and there was no fire, I went back to sleep. The next day we got in our car and it would not start. The lobster man we got to come up from the coop could not jump start it, The AAA tow-truck from Penopscot determined that the fuel pump was not working and maybe there was a problem with electrical system but for reasons I do not understand could not tow us so he left. The next driver from Bucksport made a similar diagnosis but said he could take us and car to Bangor–a long slow ride in the front seat of a tow truck but I did learn a lot about the economy and social life of Buksport. Got a new car and lost a day–got back to Stonington in just enough time to have haddock with some friends–It was good! BTW let me know if either of you get to the left coast.

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