28 January 2018
[Above photo: The view from our platform on Domwe Island. ]
It sounds like the gods are having a serious bowling tournament this afternoon. No ground lightening but continuous thunder in heavy clouds such as I’ve never heard. Now the losers are weeping, heavily. The rains have been intermittent and light this year and some areas, such as Mangochi, have had very little. Everyone gets very worried as the crops won’t grow and there is a strong possibility of famine. So this is perfect, a really heavy rain, hopefully opening a serious season of the same, even if delayed. Being dependent on the weather for your family’s life and livelihood is something from which most Americans are insulated. Oh, a freeze on the tomatoes or oranges is serious but a draught for an entire country without irrigation, which finds it hard to feed itself in a good year, is devastating.
I was called to see a young woman in the AETC (Accident and Emergency Treatment Center) today (Sunday). Since she is a student, we provide those services. 4 visits to the AETC in 4 days for emotional reasons (after a seizure, because she insisted, because she was mute, and because she became violent, respectively) demanded a good evaluation. She has “seizures” which began when she was 14yo, although she isn’t compliant taking medication, never is incontinent, doesn’t bite her tongue, and has never hurt herself when she falls down. She has a history of sexual molestation. And as I sat with her she was very gamey, variously getting up angrily, putting her arm around my shoulder seductively, talking in circles with a bemused smile on her face, and so forth. Sensing my irritation, I realized she likely has a conversion disorder with pseudo seizures, although she may just be malingering, and an underlying borderline personality disorder. She wasn’t psychotic, although she was certainly appearing “mad”, as they say here. Since I couldn’t get a thorough history from her and I felt she was quite possibly lying to me, I couldn’t feel assured of her safety and sent her to the mental hospital, notifying my colleague there that she’d be coming. I never feel angry with someone who is actually psychotic—whether with a delirium, schizophrenia, bipolar disorder or whatever. So paying attention to what we feel when interviewing patients, as we impress upon the medical students again and again, is crucial.
I never imagined that I could eat enough mangos that I wouldn’t want another. Or that the thought of them could make me feel mildly nauseous. There are so many and my impulse control so poor that I’ve arrived at that destination—-the house of too many mangos! Still, Linda makes jams and chutneys and purees and naturally carbonated drinks from them, all of which are delicious. She makes the Energizer Bunny look like a slug, and that isn’t just 77yo talking. We’ll go out for a run later; she’s up to 3 miles, I’m just starting at 1 mile. She’s trying to enter the NY Marathon for next year; I’m trying not to (and I’m winning!).
Here is a 12yo boy who has autism. He ran in front of a car when he was 5yo and sustained a coma-inducing head injury. So he’s now learning disabled, as well. He won’t poop in the toilet; but he will poop next to it. So his mom goes along with that. At least it isn’t in the living room or kitchen. He is her only child. Her husband left for South Africa years ago and has a new family there, sending no remittances home, which is an all-too-familiar story in Malawi. I want to see them every few months, as she seems to find talking about her struggles helpful.
It is so clear in teaching how 3 hour-long lectures in the AM and 3 in the PM is a no-win. Nothing remembered, people falling asleep. How the devil did I manage it, along with all of the medical students of my generation? No group role plays, no problem-based exercises or interactive lectures. Just a lot of slides and facts to remember. We did learn a lot but our teaching now seems much more efficient and fun. We know children learn better with modestly heightened affect—I suspect we do, too.
We are lining up friends and family to travel with us for parts of the summer trip and have the first few weeks (to S. Luangwa Game Park in Zambia and Victoria Falls) booked. Long-time friends of Linda’s from UK will do the first leg. Linda’s sister, Donna, who is a great traveler and has spent the last 5 months (?) on an ashram in Kerala will join us for some time early in the trip. Linda’s son in Poland, Jordan, will re-visit us, either in Malawi before we leave or on the trip. He, too, is a consummate traveler, taking short trips from Warsaw to points all over Europe.
Ah, we went to Burns (Robbie) Night again. Toasted the Queen and the haggis, worked up a sweat doing Scottish country dancing. There was a bottle of Famous Grouse at each table—I hope someone who left later than we did took it home, since we only worked our way through 1/3 of it. The Roast wasn’t as hilarious this year but we laughed at our general ineptitude at the complexity of the dance footwork. Sometimes it looked like the randomly moving molecules in a liquid on the dance floor: Brownian movement. Chaos theory. With random acts of kindness in view everywhere.
My Fulbright call from Yangon hasn’t worked x2 last week. Tomorrow AM I’ll await their call and if it doesn’t come, I’ll try to call the Embassy land line with Skype. I am dying to know whether I’ll get it or not. I just am not eager to be posted to the Military Medical School—all men, all career soldiers. Although they, perhaps, need to learn to compassionately and intelligently listen to teens and children more than at the civilian medical schools. I don’t know. My assignment does pose problems if my focus expands to include the political situation in the country.
We have two great UK psychiatrists helping us for some weeks and a third, whom we know and love from last year, flew in yesterday. We’ll feed them here tonight. It will be fun and lively and the roasted marinara sauce is making me drool. We won’t eat for 3 hours. But the sun is now shining and the world looks sparklingly new. Time for a jog.
A psychiatrist in Malawi 