[Above photo: Linda and her son, Jordan at Satemwa Tea and Coffee Plantation. He was visiting in May from Warsaw. He is multitasking, advertising his brother’s Everett, MA distillery. Best gin ever!]
5 November 2017
Linda has returned! After a 2+ month separation, during which she drove, spoke, and visited up and down the Eastern seaboard from Tampa to Bar Harbor, she is giving up the gypsy life and settling into our routines here. I expect my nutrition will improve greatly, as well as other aspects of my mental and physical well-being.
It has been weird enough with Linda gone for 2 months. But living in 2 hotels in LL and eating all meals in restaurants has added to the sense of—I was going to say “anomie” until I looked up the definition. No lack of moral standards here. More a sense of personal alienation and isolation, despite having other vols with whom I enjoy supping.
I wonder if I’ve turned into a curmudgeon, as I’m having some difficulty readjusting to thinking of a twosome rather than a onesome. It is what I want, however, so I’ll get there. I certainly was lonesome for her when a onesome. It was fun this morning, planning our trip over Christmas to the north. We’ll visit Nyika Plateau (leopards and mountain zebras), hike three days to Livingstonia (the site of the third and final iteration of David Livingston’s vision for a Church of Scotland in Malawi), and drop down to Lake Malawi and take the Ilala to Likoma Island near Mozambique, the site of a huge 150 year old Anglican Cathedral and glorious snorkeling.
Yesterday I read my nephew, Gordy Stewart’s, manuscript of the disastrous and near-catastrophic sea voyage he took in 1975 at 12yo with his brothers and father to Bermuda. They sailed the beautifully built 36’ trimaran my brother had constructed in their back yard. On the return trip, and it was about 700+ miles, they encountered an immense tropical storm with winds of 70mph and waves of 50’. The boat eventually capsized, my brother’s insulin was lost and he died in a few days in ketoacidosis. The boys were rescued by a Greek freighter after 15 days on a boat upside down in the ocean, an absolutely fortuitous save. Gordy’s account stuns me and is so vivid, without unnecessary drama, that I am transported back to that July in 1975. How those boys managed, I’ll never know, displaying such courage and resiliency. And their mother, as well. Gordy is looking for a publisher now.
On a lighter note, “Upstream fiber blockage.” Sounds to me like someone ate too much raison bran and their peristalsis balked at the bulk. It actually is the excuse used here by Skynet when the internet is really slow. Often they toss in an exotic sop, shuffling off the responsibility, “Upstream fiber blockage in Mozambique”, as if that will lessen our…what? Frustration, I guess.
Road Traffic. The words sends shivers of fear, laughter, and perplexity through me. I entered the premises at 1:45PM on Thursday with 70,000Kwatcha and left at 4:15PM with my license in hand. In between were all manner of experiences, including, “Go sit in there for the Commissioner”. It was, I found out about half an hour later when I asked, his secretary not the Commissioner. She was eating, talking on her phone, and pleasantly doing nothing. “I have to see a patient in an hour. Do you think I’ll be through by then?” “No. The Big Man isn’t here.” “Is he coming?” “Sure, sure, he’s coming.” He actually did at about 3PM, a forceful, immaculately dressed man, handsome, a bit loud. He took me before a woman who had been waiting since early morning, despite my protests. “No, Doc, you have to see patients in the hospital.” Then for the eye test and up to the bank to pay an $8 “Booking fee”. On the way I stopped to buy a copy of the Malawi Rules of the Road. “We don’t have any in English. Come back in a week and we will.” “Not one?” “Well, we might have one.” I cave, “I’ll pay some extra for it.” Another young man goes to a file cabinet and hands me a copy, for which I reward him with $2.70 since I didn’t have $1.30. Very grateful. I dig into it while waiting to pay the fee. Back to the Big Man’s office. “How old are you?” “77yo.” “You’ll have to get a medical certificate….oh, forget it.” Then his assistant whips me into a secure room to take the computerized written test. “I need to study a little.” “Don’t worry, I’ll help you.” Whereupon he takes the mouse and runs through every question so I get 100%. Kind of like the COF I described before. Then up to the bank to pay $80.00. “They’re closing. Is your day tight tomorrow?”. “Yes”. It was four minutes to four. “I’ll run.” “Don’t worry, give me the money and meet me here.” He returns, prints my driver’s license, I thank him with a 2000MWK note ($2.70) and I ride my bike, which I prefer to the car, in the light sprinkle foreshadowing the rainy season, home. So, they didn’t check my car’s fitness and didn’t check my knowledge. Or my fitness. They did do a vision test with a slick little machine, though. I guess I passed the vision test, although who knows?
Earlier in the week while in LL I consulted on a patient who was not improving at St. John of God. He was a 25yo man who had a febrile illness, dubbed “malaria” in the chart three weeks before admission, despite a negative Rapid Malaria Diagnostic Test and no parasites seen on smear. He then had a headache and vomiting, and he began to have difficulty walking and speaking. Seen in the ED’s at QECH in Blantyre (where he is a 4th year student at the Polytechnic) and at the ED at Kamuzu Central Hospital in LL where his parents live, he had a number of investigations which were all reported as normal. These included blood tests (including HIV, VDRL), a CT scan, and a lumbar puncture. When I saw him he was screaming and writhing at times, holding still at others. There was no intelligible speech and he wouldn’t/couldn’t follow commands. He was diagnosed with a Conversion Disorder. As we looked through the chart after I examined him the nurse quickly found that the attempted LP was unsuccessful because he was too agitated, there was no known trigger to suggest this was a Conversion Disorder, and there was only a verbal report of the CT saying, “Normal”. He has been afebrile during his entire hospitalization of 2 weeks; if he’d had a bacterial meningitis, he’d likely be dead. I suggested he needed an LP right away, further and more detailed history-taking from the family, and a written copy of the CT scan report, as well as a repeat of his blood investigations. I suspect he may have had a viral encephalitis and has suffered significant damage from it. It certainly looked like delirium to me and didn’t look like a Conversion Disorder. I’m in touch with the Clinical Officer about it by email.
I saw a 43yo mother of four today in clinic. She wanted to remove her youngest (5yo) child from the Pediatric Special Care Unit so she could be treated at home with prayers and a traditional healer. The girl has cerebral malaria and has been in status epilepticus; they are watching her brain gradually wither, I am certain. The poor woman lives alone with her children, estranged from her parents who live very far away, there is not enough food for them, she has been at her daughter’s side 24/7 for a week, her husband has been in S. Africa for work for 7 months and she fears he may never come back and on and on. It turns out she had a puerperal psychosis after this child was delivered. She is depressed, of course, but not psychotic or suicidal—just crushed and exhausted, watching her daughter’s potential evaporate. If I ever feel I’ve been through tough times, and I have, I am quickly snapped out of my misery by hearing a story like hers. Poverty is so destructive of family relationships and social structure, as much as it is sometimes romanticized as pulling the stronger closer to help the more vulnerable. No one who has been intimately exposed to this, or experienced it, could sustain that fantasy as negating the trauma.
It’s part of why the DT-Paul Ryan tax cuts for the superrich are so difficult to accept. Among developed countries, ours has one of, if not the, lowest tax rates. We get a lot for our bucks. What we don’t reliably get is decent national leadership and a fully-integrated universal health care plan.
I just came back from a funeral. I was notified yesterday by one of our registrars that one of our wonderful nurse’s brothers died in QECH yesterday. At least, that’s what I heard. He told me the ceremony was at 1:30PM today at HHI. “What is HHI?” Harry Henderson International School. A huge campus. After parking, I walked up to the gorgeous old church and there was a ceremony, with joyous singing. Soon I thought, boy, they really celebrate death here. Then I saw a sign on a nearby car—“Just Married”. Oops. I was pointed to another, modern-looking church which I entered and sat down. An usher came by with a flyer. “This is the funeral?” “Oh, no, it’s a 5 year marriage anniversary fund-raiser.” Oops. He pointed to a dirt road. Walking there I saw a young man and a woman sitting. “Where is the cemetery?” The result of our language limitations was that he led me into a chimbudze (toilet). We all had some laughs. I spotted a man in a van. “Can you push? I’m stuck.” Then, sizing me up, “Can you drive?”. I got in and he pushed and we eventually rocked the van free. “The cemetery is up that road.” On and on. Huge cemetery. I finally found the spot where the burial would take place but no people. “Oh, about 3 o’clock”. At 3 they came, about 75 people, moving solemnly. I saw the nurse and I put an envelope with some money in it into her purse. The ceremony was very moving, all in Chichewa, with lots of strongly expressed emotion by the immediate family of the deceased and beautiful singing by a choir of 7 women and 4 men. Such harmonies! We all sat, even the men in black suits and the women in beautiful chitenjes, in the dirt. As the nurse gave my envelope of money to our newly-minted psychiatrist, I discovered that it wasn’t the nurse’s brother who died, it was our psychiatrist’s step-brother. Finally, as I was driving out the gate I spotted the nurse, another of our nurses, and their friend all heading for the minibus stop. I offered them a ride and they happily accepted. At least I got one small thing right this afternoon.
The sun is setting, Linda is cooking something that smells wonderful, and the birdsong is deafening. The little mango tree in the back is loaded, as is the big one in front.
A psychiatrist in Malawi 