[Above photo: A friendly duiker encountered on our early morning walk across the top of Nakoma Island.]
22 June 2018
With a title like the above, you might imagine I am hungry. And you are correct. I baked two loaves of onion bread and roasted a chicken yesterday; I’ll eat some of both tonight, along with a salad. But I thought that if I delayed supper to write this, I might write faster. Not necessarily better, however…so I’ll abandon this now to eat and return after my meal. Maslow’s hierarchy comes into play. My fundamental needs must be addressed adequately before I can get to higher level functioning.
[Preparing food and eating]
Two days later…
My mind has moved on. I’m increasingly impressed by how very difficult it is to do other than rather crude therapeutic work in an unfamiliar language. Last week I searched all around for an interpreter for the adult clinic, looking in Peds A&E (Peds ED) and AETC (Adult ED) for medical or nursing students. Empty-handed, I used a woman all morning who works nearby and is a patient of mine. Boundaries, boundaries. She is a terrific interpreter, educated, experienced in mental illness, and compassionate. Today I needed her for one patient and then I saw her for her own appointment. We discussed the complexity of the situation. Since she isn’t on the payroll, I paid her the 2000MWK I ordinarily pay an interpreter for the morning. Later in the morning I called in a catatonic patient whose guardians only spoke Chichewa. As I was explaining to them that they needed to await the other (Malawian) psychiatrist, an English-speaking patient stepped up and offered his services. I took him up on it and then saw him. It’s kind of like we use bits of gauze, rolled up, as string to hold the charts together. Tonight I poured some rice to cook out of its sack, noting that the worn ziplock bag the sack was in was coming apart at the ends of the zipper. So I got some packing tape and taped the ends of the tired, ancient ziplock bag closed to keep the creepies out of the rice. You make the most of what you have here. One of the volunteers, Anna, is a family medicine doc who spends half the year in Seattle as faculty and half the year here. She said the culture-shock is much more difficult going from here to there, than from there to here. Supermarkets, obesity, and food wasted are apparently tough at first. Anna has cupboards full of saved, washed plastic containers in Seattle; we use and reuse them here. No matching Tupperware in Malawi!
But back to therapy in an unfamiliar tongue, so much nuance is lost, even if 65% of communication is non-verbal. Even the non-verbal is culturally-bound, as well.
I can see I haven’t exactly gotten my groove here. I saw a sweet little 11yo girl in clinic. She’d had malaria a few weeks ago and got crazy with it, having visual and auditory hallucinations of people trying to kill her. She was put on an antipsychotic, concurrently with treating her malaria, and referred to Peds Mental Health Clinic. When I saw her through the open consulting room door she was sitting on a bench with her mom. I waved and she checked with her mom and then smiled and waved. She was just the cutest thing you can imagine, a skinny, prepubertal girl with bright eyes, a striking tenacity while drawing the Tree-House-Person I ask all the kids to draw, and a ready laugh. I was so happy to be able to tell her mother at the end of the evaluation that her daughter’s “going mad” was entirely related to the malaria. She wants to be a nurse when she grows up, she is #3 in her class, and she is as smart as a whip. Yes, another kid with whom I’ve fallen in love.
Speaking of that, last night our guard, Catherine rattled the locked gate. I went to let her in and a tall young man across the dirt road said, “Hi, George”. I said “Hi’” back, shut the gate, and went inside the house. Later it struck me and I asked Catherine if that was her son, Joseph, who we’ve sponsored in school. Yes, it was. He’d gotten so tall, I couldn’t believe it was him. Tonight he and his immediately younger sister, Caroline, came to talk with me. We sat on the porch—I have to get some biscuits or something for these chats—and Joseph wondered if I’d located a job for him as I said I would try to do. Nope. And I told him if he wants to go to the College of Medicine (COM), he needs to dress up nicely and go there and ask how he should apply. Has he enquired of his Headmaster at St. Kellmon’s Secondary, from which he’ll graduate in early July? No. This boy comes from Manase, one of seemingly innumerable slummy mud hut villages that contribute mightily to Blantyre’s census estimate of >1 million people. His mother, and most of the people around him, never went to school. If they did, it was only a few grades of primary.
He was there for a reason and I said, “You know, Americans are very direct. Why did you want to talk with me today?” And I held out my arm in a direct way pointing at him. He laughed, knowing how Malawians seem to subtly circle an issue for awhile before broaching it. “You are my sponsor. How will we keep in touch?”. Smart boy. Smart mother. The long and the short of it is that I’ll get him a cell phone as a graduation present and he can text me or email me. He doesn’t have electricity, let alone internet, in his home or his school. [He is graduating #9 out of 80 kids. Not bad.] He seemed bewildered that a phone doesn’t just work. You have to buy little top-up cards so you have time on the phone. If he can just figure out how to keep it charged, I can call him at pre-arranged times to talk and it will cost him nothing. That settled, I suggested we meet next week, before which meeting he will go to the COM to see how one applies and I shall go to the Malawi Liverpool Welcome Trust, a big research outfit here, and talk with HR to see if they might have a job—washing glassware, even—for a smart, honest high school graduate. He needs a year or two in an English-speaking environment in order to be successful at the COM, where the teaching is all in English. Learning English in Manase like trying to learn French in Chikasaw, Oklahoma. I’m happy to pay for his tuition through school—any further education he wants, I told him. Then I turned to his sister, Caroline, who is in Standard 6 (6th grade, basically), and asked her about herself. She was great, clearly understood much of what I was saying, and seemed bright and determined. I told her that I would buy her a cell phone when she graduates and pay for her secondary school and university if she continued. She said she loves school. Then there is the littlest one, Kate, who Catherine tried to turn loose in our prior house when we were working one Sunday. She didn’t visit today, but I’ll pick up the tab for her, as well. Education isn’t a guaranteed ladder out of poverty but it is the most reliable one.
I worry that the other guards will be envious and shall let Catherine know that these things are best kept private. It warms me to think that I may help one family rise up a bit, give the kids a boost. They seem like such nice kids and were dealt such a tough hand to play. That’s it for me tonight.