22 October 2017
[Above photo: Competition among primary care providers is so intense in Malawi that expanded skill sets are not sufficient. To be competitive in this health-care environment requires time-lines for task completion. Many questions remain, however, such as seeding, irrigation, cultivation, and fertilization for breast and hips farming.]
I’m sitting in the Bridgeview Hotel in Lilongwe. This visit I do have a view but there is no bridge in sight. The room is clean and light, the shower huge and tiled, and the beds—well, their idea of a mattress is springs with about ½” of batting overlying. Still, the bed doesn’t smell of others’ sweat and the air-con and TV both work. Watford was up on Chelsea 2-0 but Chelsea came back 4-2. Huddersfield crushed Manchester United 2-1, their first victory over ManU in 65 years! Serious celebrating in Huddersfield last night.
We were “consolidated” to Lilongwe yesterday. All of the GHSP, Peace Corps, and Peace Corps Response volunteers from southern Malawi, including Blantyre urban, were driven to PC Central here via PC vehicles and drivers. The unrest in the South has been striking and spreading rapidly. The ensuing confusion suggests to some locals that the bloodsucker scare is a cynical manipulation by opposition politicians to make the incumbents look impotent. It has been working, although now with tanks in Ndirande (a huge shantytown in Blantyre) the current administration at least appears muscular. Others think that it is fostered by some to create chaos and allow for more robberies. A truck carrying sacks of ufa, corn meal, was set upon by a mob after someone shouted, “There are bloodsuckers in there.”; the ufa was all stolen. Likely it has to do with many things, including the constant fear of events beyond people’s control, such as the rain, starvation and hunger, malaria, HIV, and other illnesses, and so forth. But innocent people, 8 or more, have been killed, including some clearly mentally-ill persons. When village chiefs have attempted to calm the populace by debunking the bloodsucker tales—they escape by airplane, they use iv tubing—their houses have been burned to the ground.
The last person I saw in Thursday clinic was a 23yo man. He had spent the night in the AETC (ED) and was referred to us. I found him in our waiting room, lying on a bench, looking depleted, with no shirt or shoes, belt undone and pants unbuttoned. He staggered to the consulting room, accompanied by his sister and her 6 week-old infant. His wife and child are away for a week, visiting her relatives, so he is living alone. According to him, two men came into his house while he was asleep; one clasped a hand over his mouth so he couldn’t scream while the other inserted a needle and began to withdraw blood. He, somehow, managed to scream out loud and the men disappeared. They didn’t run away, just magically vanished. I did a careful evaluation and he does not have a mental illness—rather, a sociological one similar to the contagion of mass hysteria I’ve described in schoolgirls in an earlier blog post.
In discussing it with our psychiatric nurses, one mentioned the political angle above. Then she said, “But back in 1985, during the rule of Kamuzu Banda, men in scuba suits with flippers and gloves with long metal claws would enter people’s homes and attack them.” “How did they get in?”, I asked. “Do you know Terminator with Arnold Schwarzenegger? Well, they would turn into liquid and could go through little cracks in the door or windows. Then they’d resume their form, do their attacks, and transform again into liquid to escape.” Uh oh. I happen to know from personal experience that it is almost impossible to walk with flippers on, let alone move swiftly. If magical thinking runs so close to the surface in our mature, trained nurses, what must it be like for the 85% who are illiterate and have little schooling? In all fairness, the nurse telling me this had lost her father when she was young; he was a printer/publisher who knew too much and was killed, along with thousands of others, by associates of the late president for life, His Excellency. Given this bloody record, why the stadiums and highways named after him are not renamed is a mystery to me.
The trip north was eventful only in that one of our number drove their own car and at a gas stop slightly scraped another car. As the discussion proceeded with the owner of the damaged vehicle, our volunteer felt very alone and not supported by the ten of us travelling in the PC van. The vol didn’t recognize our driver standing nearby the entire time, next to a sizeable group of black men. The vol had met the driver before we set off, shaken hands with him, even.
It made me think about how tribal we are. At first in a new situation, other people [black, in this case] look very similar to many of us. And how many times have I, just another white guy with a beard, been mistaken for someone a black person thinks they know? Many. It is such a universal phenomenon. Until we are familiar with each other, we unconsciously don’t view the other closely enough to recognize differences. If we take our kids to a party of adults and kids, we all instantly head for our “tribe”, as do dogs and other social beings. Some of the deep roots of fear and prejudice, I think. Seeking safety through similarity, as specious as that is.
A Malawian doctor from Queen Elizabeth was stopped at an impromptu roadblock in Blantyre, threatened by men with machetes, and then robbed. We are advised not to display any medical equipment in our vehicles, as there is an association between medicine and bloodsucking. I suspect the NGO workers taking blood samples in the villages for malaria or HIV research have unwittingly contributed to this. I’d been told that hanging a stethoscope from my mirror would ease my passage past the many police roadblocks. In my trial of 1, it didn’t help a bit so I’ve removed it.
It has been fun getting to know some of the younger vols, as well as the older, here. A Peace Corps Response volunteer serving in Mangochi is 82yo. She trained as a Physician’s Assistant at 60yo and has worked for years at a time in Mozambique, Vietnam, Kenya, Lesotho, and numerous other spots. She’s having a great time and has a wonderful trove of tales. Age is just a number, although some of our bodies fall apart sooner than others’.
It is cloudy today. Does The Weather know that November is approaching? Is it then preparing the desired rains? I can hope.
I’ll put this on the internet today, somehow, although the Net isn’t working in the hotel. First, however, I need some exercise so I’ll plunge into the chitenje market as I saw a print I know Linda will love.