“Not advance, Daddy. You share!”

27 May 2018

[Above photo:  Find the three Pied Kingfishers in the tree in Majete National Park.]

As I prepared to leave the house to join a friend for some music (supposedly acoustic guitar but it turned out to be really poorly mixed, loud electric) at the French Cultural Center and subsequent supper at Bombay Palace, our guards Catherine and Cabbage (His last name is Kabbich but he goes by Cabbage) approached me. “No foodo, Daddy. No money. Need money.” It is such a common refrain, often desperate by a young child leading their blind parent around to beg. I replied, “How much advance would you like?” Cabbage was murmuring softly but unintelligibly in the background, hovering at the edge of the circle of the porchlight. “No advance, Daddy. You share. You share!”  We all laughed at the directness of her plea—and for me, the absurdity of it. I am what I imagine, from seeing how other mzungus pay, generous. How wild it would be to actually SHARE my retirement money with them. Like winning the lottery, it might throw them into chaos and misery. Or relieve the constant fear of food and shelter insecurity. I admire her for asking, something I could never do. “If you don’t ask for honey, you’ll eat wax.” My favorite Chichewa proverb.

On the other hand, I asked our gardener and day-guard, Chimwemwe, to repair the clasp on a necklace he’d made for one of our friends. When he gave it, fixed, to me, I asked how much he wanted. “You say”, he told me. I suggested 1000 Kwatcha; he said, “Fine.” When I only had a 2000 Kwatcha note, he said, “I’ll pay you the 1000 tomorrow.” Why? “Because I agreed to 1000”.

It serves as a kind of cautionary tale. He, a gardener, plumber, and artist, thinks about how he can expand and improve his repertory of skills to make a better living. She, on other hand, doesn’t do that, hoping that someone else will give her something—a house, a handout. It is clear that his is the better strategy and makes others respect and want to help him. He won’t accept handouts but is much more resilient, resourceful, and successful, than she is.

The point I’m awkwardly making is that all the money that has been poured into Africa has distorted everything and entrenched Big Men in government.  It has distracted people confronted with a problem from initially thinking how they might solve it and they instead attempt to get someone else to pay for the solution.  The end result is that it hasn’t helped and Africa has been on a downward slide. On the other hand, teaching context-appropriate skills, like healthcare practices, allows locals to learn and provide and nobody gets rich on our dime.

Last night I decided to grill a large minute steak (oxymoron?) which I had marinated for 3 days. My secret recipe, one which will finally bring my ship in, is: soy sauce, chopped garlic, cayenne pepper and plenty of cheap whiskey. Don’t whisper a word of this around! Since the guards burned up all my fire-starting wood, in one big blaze I think, I have to be ingenious in constructing the pre-fire for the charcoal. No liquid starter for me.  After getting filthy with the charcoal and fiddling forever to collect and light the paper and dried palm fronds and twigs to get it going, puffing and breathing in smoke as I encouraged it while I lay on the lawn, it finally began to ignite reliably. Then Ari called and I forgot about it for 35 minutes. When I remembered, I rushed out, headlamp on, to find…where was the grill with my fire? I yelled for the guards who thought I was done with it. We laughed a lot; they paused cooking their supper and returned the grill. The steak went on and it was delicious. There was enough fire for the guards to use afterwards. I felt a little bad, eating it in front of Polly who is a vegetarian but what was I to do?

It will be great to be in a country—the US—where I can count on toilet paper in the bathrooms, even though I feel most of it should be used to clean up the White House!

I saw a tiny 8yo boy with his mother today. They live in Ndirande, described to me as the largest slum in Southern Africa. He has been fighting in school, wandering from class to class and not engaging in anything resembling learning. His mother separated from his father, a drunk who beat her for years and didn’t give her any financial support, 10 months ago. She now sells bananas to support the family. When you figure a lot of people sell them, they are rapidly perishable, and they cost about 60 cents for 5, it is a meagre existence. Plus, the little boy walked over to visit his father and has stayed there, coming to visit his mother frequently. His tree-house-person drawing had a miniscule person and tree, and a small, cattywampus house, reflecting his sense of self and feeling of powerlessness in a chaotic world.  She was slumped in her chair and when I wondered if her life was “hard”, she said, “Yes. It is.” Both are depressed and she, certainly, cannot give her unhappy son what he needs. I’ll see them in two weeks and try to get her into treatment.

I also saw a 10 year-old girl who, two months ago, began to have headaches and nightmares of people standing around her. She’d awaken and shout, “Jesus help me.” As this continued, her parents took her to a pastor who prayed and prayed and the nightmares worsened. They went to a sangalala, a traditional healer or witch doctor, who said it clearly was magic caused by someone placing something into her stomach. He gave her some herbs but the nightmares continued. The parents, fearing that she was in the spell of a witch or a demon, moved the family into an adjacent village, living with their eldest daughter. The girl dropped out of school, since it was too far away. She was a cute, bright girl without any suggestion of a psychosis or sexual abuse. I offered that they should have the home purified—the mother suggested using holy water—and move back in, encouraging the girl to return to school and re-establishing all the family routines. I did attempt to rule-out physical and sexual abuse. I also started her on a very low dose of a neuroleptic, as these have occasionally been shown to decrease the frequency of post-traumatic nightmares and especially because I felt that the family needed a placebo. I’ll see her in two weeks, stop the medication, and hope and expect she’ll be fine.

I took my car 5km out of town to Eugene Murphy’s Motorvation, the go-to shop. It needed a rattle fixed and an oil change.  After leaving the car I trudged up the dirt road toward the highway.   As soon as the traffic was in view a minibus driver waved, I nodded and he swerved across the traffic to park and pick me up. Great spotters, they are.  Natural selection, I think, and only the minibuses with great spotters will survive, it is so competitive. Anyway, we drove down the road with a radio talk show host asking questions of the guest expert about child sexual abuse. Hm, one of my areas of expertise, I thought. Unfortunately, he asked in English and she responded in Chichewa, so I couldn’t hear her views. After we passed the clock tower, the driver pulled into a Total petrol station to buy a few liters of gas. Why they think it costs them less if they run with the needle on empty, I don’t know? They actually often run out, so they lose their place in the rush to get the next passenger.  I said, “Thanks, I’ll get out here.” He replied, “Oh, don’t do that. It’s risky. Ride to Mibawa (next to the Blantyre market) with me and I’ll escort you home.” Nice try. I laughed and walked home comfortably. There is no risk in daytime walking around that area; perhaps there is in the middle of Ndirande or Manase but even then it’s unlikely. On the way I passed a guy with tires, rims, and an air compresser by the side of the road. He’s a regular there. I asked if he could fix me up with an X-Trail spare. “Sure, what’s your budget?” “What’s your price?”  We went back and forth that way until I saw I was no match for Raphael’s bargaining skills so I suggested a price. “Could you do 5000 (<$7) more?” Of course, because it wasn’t a matter of pride. I want to have two spares for the very remote, sharp-rocked washboard roads in Namibia.  A woman who has spent months there doing bat research suggested 3.  I’ll try it on after I pick up my car Thursday afternoon.

I’m finishing this at Flavors, my regular lunch spot up a gravel road from the COM, set in the middle of the defunct Blantyre City Botanical Nursery. Lots of lovely plantings, very consistent inexpensive food, long on vegetables. I tried their hot sauce—“Flavoursome Chillies Taste Delight”—for the first time. My god, call the fire brigade!! How have I missed this during my entire stay here?! It turns pretty bland fare into a South American Cha Cha queen’s passion!  I’m slipping off the chair here, so time to post.


Roast Chicken

[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.

“Truth is Beauty, Beauty Truth. That’s all ye know on Earth, and all ye need to know.” –John Keats “That’s a complete lie.”–Paulina

[Above photo: “Goat shit and corn husks for fertilizer. If you like the size of the Blue Lake beans and English peas, you should see the tomatoes!” ]

13 May 2018

We’re both sitting on the balcony of our tented chalet, just above the water of Lake Malawi at Blue Zebra Lodge on Nakoma Island. I won’t attempt to describe it, yet another beautiful setting in which we are cared for by gracious people. The rainbow skinks are everywhere; I cannot help thinking their mothers must be so proud to have such handsome offspring. Orange and black stripes and iridescent blue tails.

We are headed in two days to our Close of Service with Peace Corps, a final gathering of the GHSP volunteers in Malawi. We’ll share our experiences and learn to do all the things we should do to leave properly: electricity and water paid, no outstanding debts, close our bank accounts, get Medical and Dental exams, write our final exit reports, and on and on. I was impatient with the 5 pages of checklist but Linda pointed out how handy it was to have so we can actually finalize our departures. The two years seem to have passed in a trice, although at times when the work was really heavy they appeared to be endless.

It is inevitable to wonder, in these circumstances, if you have made a difference in any lasting way. And wonder I do.  I did what I could and, while I can imagine doing some of it better, mostly I feel OK about my effort. Whether it was substantive or mutative is another matter.

I took Linda’s son and girlfriend to camp on Domwe Island, where we had an excellent time hiking (surprised a snake, must have been a mamba!), snorkeling (although her son finished before his girlfriend and I did and for about 10 minutes we couldn’t find him, with rising panic), eating (fresh-caught chambo, grilled and smoky), playing bao (like mancala), and laughing.

We went to the Kungoni (Mua) Cultural Center for a night to see the masks and other artifacts and to chat with Father Claude Boucher Chisala, a priest-anthropologist-artist who, over the past 50 years, has assembled a magnificent cultural history of the tribes of Malawi.  Then home for a night and we set off early for Mulanje.

Meeting Samson and our 4 porters at the Mulanje boma, we drove the 28 km around the massif to Thuchila Lodge trailhead so we could ascent the Suicide Trail.  It being latish to start up, we wanted to go swiftly to arrive at Chisepo Hut before dark. An hour into it, we were deluged for 3 hours from above and hiked, clambered, waded, and crawled up, up, up.  It was pretty maximally taxing. Everything in our packs got soaked, all clothing, sleeping bags, etc. We dried clothing and sleeping bags in front of the fireplace, ate sumptuously, and concluded the day with Linda’s hot chocolate which includes cayenne and cheap whisky.  Linda and I, at her suggestion, dragged mattresses onto the porch, found some old blankets, and snuggled in for the night. I was sure we’d awaken at 2, freezing, and have to move inside. Not so, and we slept nicely in fresh air, separate from the 8 other people sleeping inside in two rooms. It was a good choice on her part and not one I would have made.

The next day was damp but not drenching and instead of attempting to climb Sapitwa (literally “Don’t go there.” in Chichewa), the highest peak on the massif, we coasted to Thuchila Hut for the next night. Hiking up Mulanje is a great filter and almost everyone you meet is fun, interesting, and has a story to tell. Like the Canadian high school graduate who is spending a year bouncing around Africa. Or his current travel companion, a college student from Berkeley who did an elective in Uganda and now is adventuring. And on and on.  Despite the difficulty of the climb, the ferocious storm, and our thorough soaking, it was a wonderful and memorable outing. Maybe because of the hardships. There is something satisfying about laughing down adversity.

Descending the Elephant Head, another of the very steep and slippery Mulanje trails, the fog lifted a minute to reveal a striking waterfall. I quoted the above from Keats and Paulina, instantly and without knowing the poem, responded. I loved it. For of course it is nonsense, although since Keats died at 20yo (?) we can forgive him overlooking the complexity of Truth(s).

Linda pointed out how I minimized my excitement re. the Fulbright in my last post.  I am thrilled. I’ll go to Washington DC for orientation in about a month, then to Burma in January 2019. I’ll do it smarter than I did here, insofar as not taking on a large clinical load, if any.  The opportunity is to teach, to learn, and to establish ties with colleagues in Mental Health.  One year is a short time in this business; two years, I’m learning, is short. I’m not teaching a circumscribed procedure, like bedside ultrasound or reading an EKG, for which a shorter stay might be adequate.  I loved Burma when I visited for a month some years ago and expect to again.

We talked with an Australian at Blue Zebra with his wife and 3 daughters who completed much of the first part of our trip to Namibia in 2 ½ weeks a couple of years ago. He has some good tips for us for several of the areas, especially that a 2 hour fly-over of the Okavango Delta is not to be missed. His description of a pride of lions, frustrated in their pursuit of a zebra, walking past their parked open safari vehicle, rubbing on the fenders—-“Don’t move! Don’t put your hand out!”—was chastening. And watching a leopard kill an antelope and drag it up into a tree (keeping the lions and hyenas away) suggests the possibility of a wonderfully raw experience.

Again, how lucky can I be, unfettered enough to take off to parts foreign and bring something useful? And to get a Fulbright at this late stage in my career? Just sitting on this balcony on an island in a sweet resort overlooking Lake Malawi and the Dedza Hills is pretty amazing. We’ll hike to the top of the island to watch the sunset this evening.

[This morning as we hiked the crest of the island, a sweet little duiker (think very small deer), was nosing and marking the path. We froze and for the next 15 minutes we moved very slowly and stopped at intervals. It turned and approached to within 3 feet of Linda. A good omen, I choose to think.]


Majete Revisited

29 April 2018

[Above photo:  Large pachyderm in our proxcimity after bathing (in mud).]

I’m not making much headway writing this. I’m alone on the front porch of our tent-chalet, overlooking the Thawale Camp waterhole. The first distraction was the birds—a Common Scimitar-bill, a brilliant blue bird with a large violet back patch, a black head and a long black tail with a long curved beak and a nimbleness surprising to me. Then a family of Arnot’s Chats. A Bateleur Eagle just flew over. I hear Emerald-Spotted Doves and Cape Turtle Doves calling incessantly: “My mother is dead, my father is dead, what shall I do, do, do, do…..” and “Work harder, drink lager”, respectively. Suddenly an immense bull elephant lumbered out of the bush, with gravitas and purpose, to drink, spray himself, and roll in the mud at the waterhole in front of me. He then walked very close to the dining area where Linda is writing before exiting through the main parking lot. I ran up to take photos [see above].  I returned to my deck and a male nyala, grazing, passed by 20 feet from where I’m sitting. I then heard clacking and snorting and a male impala raced by, chased closely by another male. They’ve been battling for territory; often one will dehorn the other or even kill him as they crash together. The defeated one slinks away to join a celibate bachelors’ group. The victor parades around the locale issuing a loud, snorting noise to mark his territory. A family of warthogs, very tasty I am told, trotted by, the piglets incredibly cute. Oh, and a Cape Buffalo slipped into the waterhole somewhere in there.

Last night was pretty rough, as the jungle noises were substantial. Complete quiet, then intense and repetitive calling, bellowing, howling, bleating, and trumpeting (elephants). (Good lord, another immense bull elephant just entered from stage left to drink and bathe at the waterhole!)  I heard munching outside the tent screen and, looking out, saw a large, black shape feeding its way past the tent. It’s shape seemed like a Sable antelope, one of the larger and more lovely. So snatches of sleep were punctuated by very loud noises that seemed to express either ecstasy or terror. Maybe just pillowtalk. I couldn’t decifer. Finally, around four AM a pack of hyenas started barking and calling rather urgently, as if some walking protein were available to them.  Despite the lack of sleep, as we arose at 5:30AM for an early game drive, it was a fascinating night and gave me a visceral sense of what it is like to keep a constant awareness, especially in the dark when the cats hunt, lest you be eaten.  Despite the nearly-full moon, it is pretty dark under the trees and there are plenty of shadows to hide a lurking predator.  But, then, I’m anthropomorphizing the animals. This is what they know. They live in the present. They are fearful but likely not anxious. They don’t talk with each other about the narrow escape the night before. It is a constant battle in the animal kingdom and the winners get to eat. frolic, jockey for position, and reproduce another day.

A couple, a pediatrician and a nurse from Lilongwe, told us about a man asleep in his tent at S. Luangwa National Park in Zambia who was batted by a lion, giving him a deep cut on his temple. Another tale we recently heard was of a boy in Namibia who opened his tent to get a better photo of a hyena outside. The latter promptly killed him. (That’s the real version. Mine had a pack of hyenas barreling into the tent and devouring him, belt, shoes, and all, but Linda has called me on it so I’ll tell the true tale.)  All of the aggression triggered a dream in which I was observing a particularly vicious fist fight at a bus stop. One man gave it everything from the beginning, like a ceiling fan, and quickly disabled and knocked the other man to the ground. It felt chilling in its efficiency.

Now a younger bull elephant has drifted in from the side and is greeting his elder, he of the extraordinary tusks. And six White-crested Helmet Shrikes scavenge the bush in front of me.

I have been thinking of shortages, of which there is no shortage here. Start with no electricity and no water at times. Which also means no internet or hot water. We can cook on a gas burner. There is a shortage of privacy for patient interviews. There have been no sterile gloves, at all, at Mangochi District Hospital for months and the post-surgery infection rate is in the high 80th percentile. There are often no plastic envelopes for our new patient files and none to be purchased. Gas stations are frequently out of gasoline. Often there is no soap (or water) with which to wash our hands in clinic; everyone here shakes hands as a form of polite greeting, which I like. There are shortages, and stock-outs, of our small formulary of psychiatric drugs, despite assiduous inventory and timely ordering procedures.  We are short of staff, chronically. The lab is often out of reagents to perform basic blood tests. There is no shortage of patients, however.

Shortages are a fact of life here. I think they breed both ingenuity and apathy. People find remarkable workarounds, rely on history-taking and physical diagnosis more than their Northern and Western (Europe, US, Canada, Australia, etc) colleagues do, and at times feel dispirited and that their efforts are futile, given that the shortages are man-made—funds being diverted elsewhere, inefficient bureaucracies, poor facilities, etc.

On April 1 I mentioned a 47yo woman I saw in clinic with untreated seizures for 15 years, 4 years of progressive dementia, and blindness in her left eye developing over the past year. I was convinced that she had a benign brain tumor, like a slow-growing meningioma. Her MRI showed brain atrophy and extensive small-vessel disease, as well as collapse of her left eyeball. The latter is from trauma, the former from untreated hypertension. At her last visit her blood pressure was 162/103. So she’s off to hypertension clinic. She’s had no seizures since I started her on medication for the same. And she’ll visit the eye guy to see if they can determine the cause of the death and collapse of her eyeball. Untreated hypertension, chronic alcoholism, and HIV are the major causes of dementia here and often strike the middle-aged, who generally do not have access to basic medical care. We do live in quite a bubble in the developed world.

I’m starting to read a book—Linda exchanged a copy of her Sunday Morning Shamwana with Claire Wendland for her A Heart for the Work— which so far seems remarkable.  It concerns the education of medical students in both the developed world and Malawi  in Western medicine and medical technology and about the export of both to developing countries. We assume that medicine is culturally neutral, being science-based. She writes quite convincingly, as both a physician and an academic anthropologist, that the picture is considerably more complicated.  It does resonate, so far, with my experiences, both of my own medical education/indoctrination and the training and situation of doctors-to-be here.  Why is life so complex? My own included, I might add.

A nyala just cantered down the pathway to our chalet, 15 feet from where we sit. We are in the middle of it here, gloriously. There are now 14 lions in Majete and 20 leopards. All very secretive, so we have seen none.  Majete is 270 sq miles and only 30 is used for the safaris, so it is no wonder they are eluding us. No matter, on our travels in July and August we’ll see plenty, I am assured.

Jordan and his girlfriend, Paulina, are excellent travel companions and fun to hang around. I’ll drive them to Mua Mission tomorrow to see the cultural center and museum and we’ll spend a couple of nights on Domwe Island off of Cape Maclear. Linda has a full teaching schedule and must work, poor dear.

I have finally been offered, and have accepted, a Fulbright to Myanmar for the 2019 academic year, starting in January. I’ll teach in one of the medical schools there, either in Yangon or in Mandalay.  I’m quite excited about it and am already preparing myself for the year by extensive day-dreaming, most of my assumptions being, no doubt, fallacious. Burma seems far from where I am sitting at present, although time flies. “Fruit flies like a banana. Time flies like…..?”


On the Downslope

22 April 2018

[Above photo: Land crabs at Chokas Beach]

The petty theft I mentioned last week was addressed by our day guard and gardener, Chimwemwe. He stayed an hour after his usual day to speak with Catherine and Cabbage, saying that we were very generous with them and it wasn’t right for them to be taking our things. All true. We give them extra money for unexpected circumstances, pay them considerably more than our Malawian counterparts do, and overlook absences.  Shortly thereafter, Catherine came to the door, crying out “Mommie, Mommie.” to Linda. Linda opened the door, Catherine fell to her knees, sobbing, tears streaking her face, saying she was sorry. Yes, she had taken the doormat (Previously she casually dismissed Linda’s enquiry about it with, “Probably the neighbors came over the fence.”) the flashlight, the shoes, etc. She was sorry. Mr. Cabbage, whose English is worse than hers, hovered in shadows at the edge of the light, making apologetic murmurings.

It doesn’t make me feel warmly toward her, even as I can feel sorry for her and understand that someone who has rarely been given anything except babies and has very limited resources (as well as little hope of more, ever) will naturally have a hunger for things she sees in the world and doesn’t have.  The shoes, boxer shorts, and doormat have not, and will not, I suspect, be returned. The flashlight was brought back but I think it has gone missing again. Linda asked her Malawian co-faculty what would they do. They all said that their guards and housecleaners stole from them, little things of small consequence. And they suggested that as the time of our leaving approached, the pace of petty theft would pick up. They especially cautioned us re. any in-house help we might have. We have none, happily. So, we’ll mind our things, I suppose. The papaya tree mentioned last week was a male, of which we have several in the yard, and Chimwemwe simply cut it down as more males weren’t needed. That is part of the corrosive factor of petty theft and corruption, especially in government. It causes me to be suspicious where I needn’t be, which I hate. None of this is personal: just envy, hunger, poverty.

I’ll speak at Grand Rounds at Alta Bates/Herrick Hospital in Berkeley on 1 October about my experience here. I’ve been trying to distill it without removing all the impurities and complexity. I think of the women sitting for days in the dirt in the courtyards of Queen Elizabeth Central Hospital, washing bed linen (colorful chitenjes) and preparing meals for their loved ones in the hospital who may be getting worse or dying or who are just deathly ill. They chat.  They don’t sing much but they often will listen to a hell-fire preacher in overlarge black mis-matched suit jacket and trousers and white shirt, exhorting them to give up their sinful ways and accept Jesus’ love right now before they, also, like their family member in hospital, sink into the soil from which we all arose. I’ll have to give the presentation some serious thought, probably on Beach Island in September.

Jordan, Linda’s youngest son, arrived from Warsaw for a 2 ½ week visit. His girlfriend, Paulina, will join us this Friday. It coincides with a very busy time for Linda, so we’ll have to wing it some. We’ll go to the game park at Majete for two nights, I’ll take them to Domwe Island for two nights, and we’ll do other fun trips in the area. He is a very thoughtful man, an engineer working on the design of jet engines for General Electric (Apparently GE is the 800 pound gorilla of aircraft engine design and manufacturing. Who knew? I thought they made toasters!) in Poland. He is fluent in Polish, has a Polish girlfriend, bought and is renovating an apartment in Warsaw, and is learning to cook the appealing items of Polish cuisine. He’s also travelled widely in Eastern Europe, Croatia, Azerbaijan, Czechoslovakia, and returning to Georgia and Armenia 3x.  Flights are very inexpensive. He’s a marathoner and ran the Warsaw marathon with Linda some years ago. And has an enquiring and wide-ranging mind. And is devilishly funny. It is very nice to have him aboard and we can’t wait to meet Paulina.

We give this group of medical students, 25 in all, exams this week. A mutual feedback session on Friday morning will complete the rotation, my final one.  The students are a the bright lights here; I hope they aren’t dimmed or extinguished by the end of 5th year—or their 18 month internships. Salaries are so poor and positions so few that in spite of their good education and intentions many may flee the country for greener pastures.

Speaking of bright lights, they have installed 17/23 new lightbulbs in the College of Medicine hallway where we have our offices, which is quite a pleasant surprise. I didn’t expect it. Of course, the 5 dead bulbs at the Department of Mental Health end of the hall haven’t (yet) been replaced. Am I being paranoid? Or did Microbiology just make more squeaky noises than we did?

I saw another fascinating film in Lucy’s series: The Last Animals. It’s about the slaughter of elephants (for ivory) and rhinos (for horn) in Africa. It was made by Kate Brooks, a celebrated war photographer who has spent years in Afghanistan, Iraq, and Syria, and is miraculously still alive. She saw her task, correctly I think, as reporting on another war. 100,000 elephants and 5000 rhinos were killed during the making of the film. Two of the last 5 Northern White Rhinos on Earth died during the filming and the last three have no hope of reproducing as the male has a low sperm count and the females are apathetic and less than interested.  The elephants are often shot in the top of the head from helicopters.

I am struggling because demand for the ivory and the horn is largely from China. The Chinese are also cutting and exporting timber, oil, and minerals, both legally and illegally, all over Africa. Certainly in Malawi and Mozambique the destruction of forest is massive. There are over a million Chinese now in Africa, mostly coming in the last 20 years and economic ties between China and many African countries are extensive. It seems to me that they are colonizing and exploiting African countries, certainly with the acquiescence of the African leaders. Regarding the animals, rhino horn is like fingernail clippings but Chinese belief is that it is an aphrodesiac and will generally improve your health. Ivory is made into carvings, jewelry, and backscratchers.  Poor peasants here are given new AK-47’s, making them better-armed than the animals’ guardians. The peasants don’t get rich, of course. But the large smuggling syndicates, which also traffic in drugs and sex-slaves, make huge profits. Ugh.  How to stop the demand?

This is a very dark series, Lucy. Fascinating and I’m grateful you put it together but I’m glad it is only one film per week!

I am planning to write a list of tasks to complete before I leave. I know that if I don’t I’ll leave some important ones undone. I’m unsure why I don’t just do it. I feel as if I’m procrastinating before writing a final paper for a course. Part of me feels that I don’t want to give myself a huge worklist, that I’ve worked hard enough over two years. But it nags me so I’ll start it now.  Tasks deferred always take more out of me than if I just did them.

Here’s a nice closing quote I came across. From Voltaire. “Uncertainty is uncomfortable. Certainty is ridiculous.” It works well in my chosen field of work.

Luck of the Draw

15 April 2018

[Above photo: The beach at Ossimba.]

It is stressful for me to have much more money and security than do the people around me. It is more stressful for them, of course, and I’m not lamenting my position or about to give away what I have. For me, however, it just is an everyday, often in the background, stress. It must be for most people, although for different reasons. I’ve noticed in my work in Berkeley with some truly wealthy people that they often become identified with their money, especially if it was inherited.  It assumes a large place in their life, and they fear it will be taken from them. I’ll admit that I sometimes wonder what would happen if my annuity company went bankrupt, the Republicans got their way and my Social Security was cut to nothing, or if someone hacked into my bank account and electronically siphoned it all away. But I don’t think about it often and I know how to live frugally. Plus, I’m currently fortunate in that I am healthy and can earn a good living if I need to. Even now, being a Peace Corps-Seed volunteer who gets a living allowance generous enough to live on in Malawi, I can leave my retirement monies alone and they can accumulate.

Our guard and laundress, Catherine, often asks me for things. “Daddy, I want a chicken.” “Then buy one, Catherine.” “Daddy, I want a rain jacket.” Her most recent was, “Daddy, buy me a house.” Really. “What does a house cost?” She came back two weeks later with house prices, anything from $2000 to $32,000. I realized I should have just chuckled with her. She obviously took my enquiry seriously. Now, I can afford that. It would make a huge difference to her and her kids. Why don’t I just do it? Well, what about the other two guards, Mr. Kabbich and Chimwemwe? Shouldn’t I give them an equivalent amount? How about the Mental Health Nurses I work with, who are smart, hard-working, compassionate, and are paid peanuts? Or our recently-graduated psychiatrists who are paid ridiculously low sums and carry considerable responsibility, in addition to having spent long years in training?  Or the patients I see who are obviously in extremely tight circumstances with no way out?

Linda has a much healthier and better-boundaried attitude than I do. She’s no less compassionate. She thinks we should give them each an extra month’s wages before we leave. And I’ll continue to pay for Joseph’s school through university, as well as his younger sister’s when that is necessary. It is, however, difficult to think of people with food and shelter insecurity their entire lives. Catherine asked Linda for money for a uniform (She gave it to her.). “All my children are in school. I’m going to go to school.” Good for her, as education is a way out. It is not like in the US, however, where there is so much money in the System that a person coming from nothing can actually earn a decent living with some education. Here she can do better than if she were uneducated, although it will always be a pinch.

It is a bit of a help to my often poorly-considered generosity that things outside the house have been disappearing. Our door matt.  A solar-powered lamp, which was a gift and was inadvertently left outside to charge, vanished overnight. The original flashlight—“It is broken and was thrown away.” Who knows if it was thrown or simply taken away? I bought another for the night guards—now that is gone. Both pairs of Croc-type shoes we kept on the back porch to walk in the garden are gone. A pillow was gone from the wicker couch on the front porch, but I found that today on one of the guard’s chairs in the guard hut. All of the kindling I purchased to use as a charcoal starter for the rare occasions we grill was stored under the wicker couch; none is left. And when I went to collect my boxer shorts—you don’t ask the laundress to wash your boxer shorts—this morning from the line, one of the pairs was missing and two clothespins were left.  Yesterday Linda noticed that a 5’ high papaya tree in full bloom that we have been watching has been carefully removed and the hole filled. It is irritating. They are “guards” but there are times when they don’t overlap and in the middle of the night they sleep, naturally, in the hut by the front gate. Are they stealing this stuff? Is someone coming over the wall, which isn’t difficult as I’ve done it twice after I’ve forgotten my gate key? A bit of the social contract is torn but I don’t have much interest or energy to mend it, if that were even possible. I’ll talk with them about it tomorrow night.  The small larcenies of every day.

Malawi has the lowest per capita income of any country in the world, according to the World Bank. The UN extreme poverty line is the equivalent of $1.90/person/day. Malawi is $0.68/day, and that figure includes people making good salaries as well. Not much is produced or saved here. Subsistence is the way of life and food, health, education, and other securities are grossly lacking. Many people cannot afford to come to our clinic monthly because they live at some distance and the minibus fare is $1 or $1.50. Malnutrition and stunting are prevalent—while some older people are overweight, most people here are very slender, both from physical labor and caloric deficiency. 18 million people to become 34 million 16 years from now.

Mozambique, with only 11 million more people, has >7x the land area. And lots of mineral wealth. Trains filled with coal regularly come to the northern port city of Nacala from the mines in western Mozambique.  Huge coal-carrying freighters are lined up outside the port (5 or 6 at a time) to load and carry the coal to India. Delhi’s air is supposedly worse than Beijing’s; they just haven’t publicized it until recently because then they would have been forced to address it.

I saw a very good documentary in a series at the Polytechnic University that a friend, a BBC journalist, assembled and got the American Embassy to fund. It is called “The Worker’s Cup”. The companies building the stadiums and facilities for the 2022 Soccer World Cup in Quatar use desperate migrant laborers from Africa, Asia, and the Middle East. The money to be generated is estimated at $14 billion. The UN and Amnesty International shone a light on the inhuman treatment of the laborers and in response, to spiff up their images, the construction companies supported the assemblage of 22 soccer teams from the thousands of workers to compete in their own Cup series. Of course, like nearly every male in a developing country, each of the men had failed dreams of getting out of poverty via professional soccer. The government wouldn’t let journalists report on the working conditions but needed publicity of the Worker’s Cup to counter the evil image the businesses had spawned. So the filmmaker used coverage of the tournament as a way to access the men. What emerges is a heart-breaking portrait of life as a poor person from a poor country, the remarkable humanity of the laborers, and the cynical sop thrown to them. Ironically, because of the publicity the tournament generated, recruitment of laborers from various countries improved and it was overall a financial boon to the companies.  It is, I think, a metaphor for professional sports in general: much money for a very few owners and players, false hopes and promises, lots of damaged bodies and spirits, and a huge distraction from the real issues adversely affecting people’s lives.

I can see I’m in a downward spiral today. Moods here follow a sine wave curve. It is time to head home, which will happen soon. Given DT’s antics, I’m counting on the courts to cheer me up. It has been a great opportunity, as well as extremely painful at times, to work and to live here. As desperate as people are, they still dance, sing, drum, fall in love, work, and are not as violent as the disenfranchised in the US. A sweet little country which feels doomed, to me at least.

On the Beach

8 April 2018

(Above photo: Sunsets in Mozambique are extravagant!]

It is impossible to adequately chronicle all the moments of surprise in a vacation like this, so I’ll only talk about two destinations at which we relaxed.

From Ilha (eel-ha) we drove to Chocas Beach, which we’d been assured was the loveliest beach in Mozambique. Since the journey, not the arrival, is the centerpiece, I want to note that Linda is a terrific driver, especially on storm-drenched mud tracks. The 40km from the tarmac to Carruzca (cah-ruszh-cah) Mar y Sol, the original resort on the beach, was slop, with at least one stuck car we had to pass. At another point a couple exiting in a large HiLux 4×4 cautioned us that the “next 20km is really bad”. Undeterred, we continued to slip and slide up, down and around, meanwhile watching the gas gauge drop below 1/8 of a tank. We were told there was a gas station at Moussaril, before Chocas, so we worried a bit less. Of course, when we arrived there it was closed, the attendant couldn’t be roused by telephone, and we continued to the beach.

It turns out that the foreign tourist industry, which recovered after the end of the civil war in 1992, has been in decline for 10 years. It isn’t clear why, although raising the visa fee to $100 has clearly discouraged the backpacker crowd.  The place was nearly deserted.

We had a sweet and simple thatched cottage, completely isolated from others, 50 feet above the beach. The latter was soft white sand stretching far each way into the distance and fringed with coconut palms, deserted and pristine. Imagine the Indian Ocean as large irregular patches of aquamarine and violet—our view. We’d swim, read, eat grilled prawns marinated in salt, lime, and garlic, and relax.

The first morning we were there, gasoline anxiety was at the top of our list.  I set out with “Mr. John”, with whom we’d arranged a later boat ride, to find some gas.  What I’d forgotten about was the informal economy. There were a fair number of small displacement motor bikes, as well as some outboards, in the area. People would take all their one liter Fanta and Coke bottles to the gas station in Mousarril in the morning, fill them, and go home, displaying them at the roadside on a table or on the ground. We’d get 2 liters here, 5 liters there, and so on until we had added 16 liters to the tank. The gas station, by the way, had “a very small tank” and it was empty so the station was, again, closed. I’m not exactly certain how it all works but since the “Empty” light went on during our quest, it was a relief to raise the needle.

Later that morning we took a ½ hour boat ride to Ilha Siete Arboles which had recently been expropriated from its Spanish owners by the Mozambique Minister of Defense, who planned a hotel for it. It was hot and quite barren, excepting a thatched shelter, a few trees, and a small concrete swimming pool with a foot of algae in the bottom, perfect for breeding mosquitos. After a snorkel among some living and some dead coral during which we saw a number of small, colorful fish, we headed back to eat and read.

One afternoon we walked the length of the beach going south, looking to have supper at a fancy resort about which we’d heard. We saw hundreds and hundreds (so, possibly, thousands?) of land crabs scuttling into and out of their holes in the sand and into the sea to avoid us. Very dainty, speedy creatures, looking just like Sebastian from “The Little Mermaid” with glistening black eyes on stalks sticking up into the sky. We passed a large encampment of fishermen on the beach; it was so remote that I felt uneasy. Linda didn’t—“They think white women are ugly.”—and thought my concerns were unfounded. We didn’t find the resort, which was further than we thought so walked part of the way back in the dark along the tide-flooded sand track behind the beach at the edge of a huge mangrove swamp. We discovered a pretty, simple newly-opened thatched bar, had beers, and talked at length with the owner.

Kent Powell is from Wilmington, North Carolina and knew Bel Haven, where my sister-in-law, Pat, grew up. He came to Mozambique 15 years ago as a missionary. He founded and built an orphanage, a school, housing for his teachers, and so forth. He found that caring for 300 orphans and running a large organization was not the work he wanted to continue, so he left it in the care of Mozambicans,  married a Brazilian woman, and they located this property. He now has two simple cabins for rent, a fledgling bar/restaurant and 30 acres on a spectacular beach. He was an appealing guy, figuring it out as he went along. After visiting and watching the magnificent sunset, we dropped back to the beach and headed to our cottage. On our return walk there were even more land crabs and they often waited too long to escape, scrabbling across our bare feet and looking like so many tiny ghosts in the moonlight. At supper we shared a table with the only other couple at the resort. They are from Blantyre, he is an Italian who teaches primary school and she is from UK and works for an educational NGO. They’ve lived in Malawi for 15 years, not wanting to raise their son in Europe. They come to Carruzca every year for their vacation.

The next morning we left for Nuarro, a very high-end and remote resort with its own airstrip at the outer tip of the northern shore of Nacala Bay. It had been touted to us in Ilha by a Mozambican woman who had gone there with girlfriends. We thought we’d splurge a little. It was a long drive over a dirt track through villages, poorly signed. There had a been a deluge the previous night; we had watched the amazing near-constant lightening display from our cottage at Carruzca. The road got worse and worse, deeper ruts, bridges washed out requiring us to cross rivers, whole chunks of road simply dropped off into oblivion, massively deep and extensive puddles. Our little car is remarkably capable, it seems. Finally, after 4 hours of hair-raising driving, as we thought we were approaching Nuarro—we were still actually 25km away—we descended into a broad valley and the road vanished into a kilometer of deep, churned mud. We started through it but halted 1/3 of the way, realizing if we continued we’d spend the night stuck there with adequate water, one piece of bread, and no bedding. Villagers were having difficulty walking through it; the rare motorbike was up on the side being pushed through the maize fields. After deliberating, I managed to turn around and we backtracked most of the worst road before it got dark. Finally arriving in Nacala, the busiest port in northern Mozambique, we struggled to avoid all the 18 wheelers carrying shipping containers, tried not to run into the many motorcycles with no head- or taillights, avoiding potholes so large they would tear off the front wheel if hit at any speed, and, with Linda’s excellent navigational skills, we found our way to a backpacker’s lodge, a clean, quiet cottage, and supper with Laurentina Pretas (Guiness-like stout). We slept well but decided in the morning, after Linda searched the internet, to go to Ossimba, another high-end resort but at the outer tip of the southern arm of Nacala Bay.

After two hours of false starts and dead ends, including a trip to the new and lovely but deserted Nacala International Airport, we went for lunch at The Thirsty Whale.  Linda knows the owner of a same-named tavern in Bar Harbor where we’ve eaten and wanted a photo of the place. The owners were Zimbabwean, very helpful and one of them, Mike, had visited Ossimba that morning on a long run. He drew us a map and after delicious shrimp in garlic sauce, we headed out. Another challenging road but only 15 km and we arrived at paradise.  Set completely apart from civilization on 1.5 km of a spectacularly lovely beach bracketed by cliffs—with no habitation visible beyond it in either direction—was an elegant resort with 10 individual thatched cottages, an infinity pool, and a central lounge/dining area. It all was perfect, including steps cut in the lava rock down in front of our cottage to the beach. We were the only guests at the time. We’ve had great seafood, snorkeled and swam, read and painted (Linda), and talked and talked.

We’ve put ourselves in many adventure-filled situations which are fun but stressful. Stress can both bring you together and drive you apart, both of which we’ve experienced.  It is a challenge to drive over very difficult roads; it is more of a challenge to be the passenger. Everyone’s driving calculus is different, naturally. At base, we are both very competent drivers and caring people.

The two years in Malawi have been fun and meaningful and eventful and difficult. That it is all ending soon is not easy, even as we are ready to return to the US, at least for awhile. When the stakes are high, our differences seem more important. We’ve chewed on this bone a lot during our vacation.

Practical lessons we’ve learned. 1) Always fill up your gas tank, no matter how full it is, at the last known station. 2) Always carry some food and plenty of water in the car, as well as bedding.  You may be spending the night somewhere unexpectedly.  3) Be prepared for directions and the criticism of your driving from the passenger if you are on a difficult road.  Their anxiety is much greater than yours because they don’t feel in control (and aren’t!). 4) Get at least one SIM card and phone top-up between you for each country you are in. The ability to call for emergencies and directions/reservations is a great time-saver.

As we walked along the beach last night in the dark after sunset, stars appearing overhead and lightening flashing to the north, Linda said she was ready to head back. Surprisingly for me, I felt, and said, that I would like another day or two. I mean, we’re in Paradise.


1 April 2018

[Above photo: Water transport from Ilha Mozambique.]

Wednesday morning at the Room 6 Clinic meeting I told all that I’d be walking out of clinic at 12N so as to get a start on the drive to Ilha Mozambique. The last patient the students presented to me was a 47yo woman who had the onset of a seizure disorder without antecedents at 32yo. For the past 4 years she has been increasingly forgetful, is occasionally confused and aggressive, wanders aimlessly at times, and has been having up to 3 seizures a day. In addition, over the past year she has lost the sight in her left eye. Her HIV status is unknown. She’s been given carbamazepine 200mg/day,  a miniscule dose, for her seizures and, recently some chlorpromazine for her “odd” behaviors. This was not a simple case and her mismanagement has been legion. I suspect she may have a non-malignant brain tumor, although there could be all sorts of reasons for an early dementia in this country.  We attempted a Montreal Cognitive Assessment test but she couldn’t do any of it. I discussed her care, including her poor previous care, with the medical students, ordered the requisite lab work, and managed to exit clinic by 12:10PM.

Linda was already home and we packed, closed up, and headed for the border. A bridge on the direct road to Mulanje had washed out so we went the longer, but prettier, route through Thyolo and the miles and miles of rolling green tea fields. The border crossings—leaving Malawi and entering Mozambique—were quite easy as our papers were all in order.  We probably should have gotten our visas at the border; $50 vs. $75 at the consulate in Blantyre. We didn’t because we wanted to speed through but considering the 2-3 days it took back and forth to the consulate, the bank, etc. to get them in Blantyre, it would have been a good trade-off.

The roads were mostly all tarmac, very few potholes, passing lines painted in the middle, yellow shoulder lines on the sides, broad paved shoulders for the cyclists, and speeds of 70mph were possible. It felt like driving in S. Africa, but with almost no traffic. We flew and pulled into Mocuba about 2 hours after sunset. We found a clean but unmaintained hotel and collapsed for a good sleep. The next day we sped 8 hours to Ilha Mozambique, crossing the several km one-lane bridge to the island. It was the Portuguese capital of Mozambique for 4 centuries and one of the two major slave departure sites (Zanzibar was the other) in East Africa.

Our hotel, which was a bit tough to find, is a grand old house down a dusty walking alley with a large open central courtyard, 3 (huge) rooms beautifully outfitted, and terraces on both floors and the roof. The latter is for sunset and moonrise viewing, the second floor is where we have breakfast with the garrulous and amazingly informed Italian owner, Bruno, and Judith his lovely Mozambican wife. Breakfast, I should mention, is an assortment of freshly-baked breads, home-made jams, an avocado mousse, eggs, juice, quiche, ham or prosciutto, and lemongrass tea followed by coffee. All interspersed with lively conversation with the other guests and our hosts.

We walked all over the small island yesterday, trying several recommended restaurants, as well as local places. We’ve been in at least 3 that are much better than anything in Blantyre. The shrimp is glorious and the tuna perfect. We hiked through the huge fortress on the north end of the island, where the Portuguese were garrisoned and where the slaves were kept. Looking over the ramparts past the brilliant aquamarine and purple sea, it is amazing to think how cruel we can be to each other for a piece of gold. All the stones for the fortress were taken from the middle and southern end of the island where the current very poor Mozambicans have their shacks.  As a result of the stone removal, the entire area is 10 or 12 feet below the road level. Flooding has been a huge problem and they have finally built a large culvert system with pumps to remove the excess water. The wretched of the earth. But people are, as in Malawi, friendly and don’t express anger when you don’t purchase what they are trying to sell.  Vendors walk through the streets with steamed seafood—clams, oysters, lobsters, etc—heaped high on platters they carry gracefully on their heads, hands-free.

Because I have been so damn ill—2+weeks of a cold, cough, fatigue—this is a very mild vacation for us. No mountains to ascend, rivers to ford, wild beasts to battle.  I’m looking forward to a sunset dhow ride this afternoon with beer and snacks. Someone else minding the sheet and tiller. The lateen rig is something—a single forward-canted mast, a loose-footed triangular sail, and gradual propulsion across the water. We’ve seen a few tiny dugout canoes with a similar rig, using black plastic sheeting for the sail. Poverty and necessity, coupled with ingenuity, are the parents of invention.

I’m finishing Robin Knox-Johnston’s book, Cape Horn, an account of the discovery, mapping, and commercial exploitation of the Cape Horn route to the Pacific.  It is an amazing account of the many, many players, so many of whom perished along the way. Descriptions of the “greybeards”, 100+ foot steep breaking waves, encountered off the tip of the Horn are chilling. The energy contained in them repeatedly destroyed large vessels if struck at the wrong angle. Massive storms and powerful ocean currents made the passage nearly impossible. The clipper ships, those spectacular greyhounds of the sea, which we associate with the Cape, were only around for a couple of decades, preceded for centuries by heavier, slower sailing craft and replaced by steamships when the latter came into service. Reading his account has certainly cured me of any adolescent fantasies of circumnavigating, even if I used the Panama Canal. I’m suddenly aware of my mortality and frailty and even though I’m active, I wouldn’t have the stamina to undertake such a voyage. Nor, at last, the inclination. Whew, what a relief!

As I write this on a terrace of our hotel, shaded by a huge-leafed tree of some sort, someone is playing electric blues from the 60’s and 70’s. I see banana trees rustling in the breeze over the wall next door. I hear some thunder in the distance. Linda bought 3 pretty chitenjes in the off-island Sunday market we visited this morning with new acquaintances from the hotel and is roaming about town while I write and rest. Ariane is in touch with me. Life is pretty sweet.

Death’s Sting

25 March 2018

[Above photo:  A poster in a mission school, high in the Misuku Hills. Who could handcuff those sweet, kempt little children? Hilarious! Like “Crooked Hillery!”]

Sitting on the front porch in the early morning cool, birds flying and feeding and singing all around me, I sought the correct note. Notes, actually. I started with a Bach Cantata but it was much too complex and lively for me to play as background to writing. A Hayden quartet—-too formal.  A Schubert piano sonata. Ah, a Schubert string quartet. Just as I got it started, there was a calling at the gate. I’d texted Chimwemwe not to come in until 1PM.  I like it without guards when I am here.

Catherine called out, “Daddy”, as she calls me, in an anguished voice. I rushed to open the gate, fearing the worst, that her daughter who had been ill this week had died. Her brother was accompanying her and she fell into my arms sobbing. Her uncle, from a village near Chikwawa, was rushed to Queens early this morning. All she could recount was that he had nasal oxygen cannulae and couldn’t catch his breath. He’d just died. She asked, “Where is Mommy?”, as she does whenever she sees me. Linda is her primary go-to person; I’ll do in a pinch. I got her some money—-about $25 which is 2/3 of a month’s salary—figuring since it wasn’t her child, as with our guard, Cabbage, when his daughter died, she wouldn’t be expected to pay for the funeral costs. She was grateful, sobbing and hugging me, and turned to go to the hospital with her brother. Perhaps the morgue, now. His breath caught and he sobbed once, which is pretty unusual for a Malawian man. At least in front of another man. Anyway, I was tearing up and with all the unconscious grief and empathy flowing around, he likely didn’t have a choice. We are social—herd—critters.

I had opened the NY Times on my computer to follow the reports of the gun-control marches just before Catherine and her brother appeared. It is heartening to see the energy. I hope it isn’t dissipated or distracted with a pre-emptive strike somewhere. Civil Rights, Vietnam, La Huelga of the Farmworkers’ Union, LGBTQ rights, Women’s rights, and so many more extensive displays of peaceful protest have forced change in this country.   As I understand it, the Second Amendment was to allow small groups of justifiably-suspicious farmers to oppose attempts at tyranny by the government of our newly-minted nation.  With its military intelligence, weaponry, and determination, there is no way in hell that armed civilians, even in clandestinely-trained militias, could overthrow a tyrannical government. It would be a one-sided slaughter. Besides, we’ve moved beyond baring our teeth and fangs; we can vote and encourage others to do the same.  As the man said, “Follow the money.”, which means the money the gun manufacturers and lobbyist rake in and the portions of that the politicians demand for their support.  If we want to raise ourselves up out of the dirt or step out of the jungle into the sunshine, we’ll have to stop bareknuckling it as a first response to dis-ease.

After we put my daughter’s (and my—I cared for him for half his life) dog, Oscar, down, I felt a desire to keep walking the familiar route we had taken each night up in the Berkeley hills. But without him—-a gentle but fierce-looking 115 pound OBD (Oakland brown dog)—I felt vulnerable. Predators tend to hunt at night. One evening’s walk I carried my Opinel wooden-handled folding picnic knife in my pocket. I spent the entire time alert to danger, planning how to unfold and lock it open in a hurry without cutting off my fingers. It ruined my walk and made me unnecessarily frightened. So I walked, unarmed, recalling with pleasure all of my nocturnal circuits with Oscar. Sometimes he’d sniff so much—“Who was that? When were they here? Is she single or does she have a friend?”—that I’d get far in front of him. Then I’d sprint off to see how long I could hold the lead.  Once I turned to cross Claremont Avenue, which at 11PM was empty.  He cut the corner short, we tangled legs, and I went down onto the pavement head first, hands jammed in my puffy jacket pockets. My first thought was, “Jeez, I could have had some fun fighting in high school because I clearly don’t knock out all that easily.” I got an excellent black eye out of it, and made good retorts to enquiries: ”You should see the other guy.” Anyway, outgrowing our adolescent aggression is especially important when we have nuclear, not just muscular, arms. Let DT and Kim Jong-Un slug it out. As long as winner doesn’t take all, since I don’t think Mr. Orange Mashed-potato could punch his way out of a soap bubble.

Oh, my god! I have been waiting for the Sunbirds to arrive and just in the middle of this violence-referenced rant, a collared Sunbird appears and is extracting nectar from the lantern-vine flowers 8 feet from me! I like Good Omens, and this is instantly recognizable as one. A gorgeous and tiny creature, iridescent green cap and cape, bright yellow bib, breast and underparts, a tiny band of blue under the neck, and a short, jet-black curved beak.

I’ve been pretty ill for a week. I thought it was a cold from sitting, eating, and sleeping in air-con for 3 days at the conference. Stefan suggests that the Brits from Kings College London brought in a bug. I continue to cough and bring up all sorts of guck, even though I don’t have a fever. Our friend, Sophie, with whom Linda is this weekend, is an acupuncturist and offered to stick me. I thought, what’s to lose? I was curious, as well; years ago I saw the first widely available 8mm film of acupuncture treatment in China, taken by Victor Seidel MD (Mt Sinai Hospital, NY).  In it a woman was being fed some lychee fruit while her gall bladder was being removed. And after brain surgery, another patient got up and walked to his room. Stunning!

I took a taxi out of town to Pa Hruntzi, an old mansion on spacious, overgrown grounds turned into a permaculture training site, an event center, and the location of Sophie’s office. After taking a history, when she put in the 5th needle, I started to pass out. After taking the appropriate measures, we were able to continue. I later realized I’d had 2 cups of tea in 24 hours—period. When I got home, I tucked in the mosquito net in preparing to retire and suddenly was on the floor. I’d had no sensation of dizziness, just that people were battering me with wooden chairs on the way down. The chairs would be Linda’s dressing table which I crashed against as I sank. Anyway, no permanent damage done.  I’m convinced that I have PPLO, Atypical Pneumonia, Mycoplasma pneumonia, or whatever it is called these days and shall start a macrolide antibiotic now.  Pause. First day’s dose is in.

My final take on Paul Theroux’s Dark Star Safari. He’s a fine writer but too pretentious, dropping names and positions. He’s hypocritical, dismissively demeaning of American tourists on camera safaris while he sometimes takes super luxury trains, eats in elegant restaurants and stays at a fancy waterfront hotel in Cape Town, enjoying all. At times he is an admirable adventurer, but then that’s his occupation.  Most people don’t have the time on the ground, or the inclination, to rough it as he does. Why put them down? And to minimize the beneficial impact of foreign currency flowing into an impoverished continent via tourism—for Africa is so beautiful and increasingly suited for the same—is silly. It provides huge incentives to protect species and the environment. He’s a voyeur, just as they are. He simply writes about it and is paid handsomely for it. And always has a plane ticket home.  It seems he’s trying to say, I’m living like a poor African lives, so I really get them.  He can endure dirt, bad food, dangerous circumstances, and major discomfort. But he can never really get the mind set of someone whose lif e circumstances, including future outlook, are so different from his own. No one can. Also, when being critical of Africa, look at our inner cities. And our politicians/political corruption. The last book of his I’ll read, I think, unless he takes time to examine himself and his motives with the same scrutiny he reserves for the subjects in this book. Short-sighted, mean-spirited.

I got another teaser from Fulbright. The East Asian group of scholars will convene in DC for three days in June for a briefing and to meet each other. I’d like to go to it if they will shoulder some of the costs.  I know not to get into political discussions in Myanmar, unlike a friend and colleague’s son who actually made a tape recording of Aung San Suu Kyi when she was on house arrest and then smuggled it out of the country.  Risky to do without significant upside benefit, especially apparent in hindsight. I’ve spent enough time in low-income countries that I know how to exist comfortably. I am excited to teach in SE Asia. If Myanmar isn’t a fit with the US right now (Where is, given our chaotic, disrespectful, and lurching foreign policy?), I’ll try it through another country there.

OK, the real news is that my daughter tried, unsuccessfully, to text me and so sent me an email that she’d like to talk with me. We wrote back and forth a bit last night and I’ll FaceTime her at 3PM Malawi time today.

An account of death and guns and fear and illness and Oscar and a Sunbird and Theroux and the future and, finally, my daughter. It is a lovely day here, about 75 degrees in the shade with a soft breeze blowing and small, but growing, puffs of cotton bobbing in front of the blue, blue sky.  Stefan and Lucy, feeling housebound and with two loaves of bread in her oven, are going out to lunch and asked if I’d like to join them. But, of course!

Inspired Students

18 March 2018

[Above photo: The Mua Mission dance troupe.]

AMARI (African Mental Health Research Initiative) is a brilliant project (another) of the Wellcome Trust, UK’s largest health care research funding source. It is a joint venture of medical schools in Malawi, Ethiopia, Zimbabwe, and South Africa to develop researchers and career pathways for them so they can understand mental health and illness in sub-Saharan Africa. At the annual conference in Lilongwe last week, 47 MS, PhD, and Post-doctoral students presented their research. And the program has only been running for 2 years! It was thrilling to see eager, intelligent young Africans moving toward common goals that will benefit all of us, most certainly their countries and immediate communities. In addition to providing understanding, they will develop innovations in health care for [better] delivery of effective mental health interventions, both at the individual and public health level. Some greybeards from the respective universities, as well as from Kings College, London spoke at the conference, also. Their perspectives were a welcome contrast to the meat and potatos of our work at the College of Medicine.

I did get a cold from the constant air conditioning in the Bingu wa Mutharika Conference Center (I now understand why we have power outages in other parts of the grid!) but it was hugely overshadowed by the excitement of the conference. Stefan, Chiwoze, and Dalitso of our Department of Mental Health were the local organizing committee and did a fabulous job. Great rooms, great food, the best conference bags ever (colorful silk-screened cichlids from Lake Malawi), and excellent conversations. 72 psychiatrists in Ethiopia but not a single Child and Adolescent Psychiatrist. Nor a Child and Adolescent Mental Health Clinic.  National mental health budgets are generally less than 1% of the total health budget but mental illness creates 10-20% of the health burden—-direct costs, work years lost, family and economic disruption, etc.  >50% of the population is 16yo and under in most countries. Half of all adult mental illness declares itself by early adolescence. And on and on. Lots of work to do to address the problems upstream. Get ‘em young!

We saw incredible traditional dancing by a troupe from the Mua Cultural Center, the richest trove of traditional culture and history in Malawi. The  Center was built by Father Claude Boucher who has been at the Mua Mission (as a White Father, referring to the Order’s robes, not their skin) for 50 years and has created a magnificent museum of masks, photos and cultural artifacts, as well as workshops for traditional craftspersons and performance artists. The troupe members sang, stamped, beat drums, clapped hands, and danced stories from the Chewa and Ngoni past—tales of the harvest, slavery, the advent of HIV/AIDS, puberty rites, fertility—all with costume, skill, and immediacy.

The HIV performance began with drumming by the men and singing and syncopated clapping by the women—enter a tall, slender man with a dark hood over his head, a dark loincloth, and holding a bundle of flaming sticks in each hand. He danced wildly, with the flames singeing his legs and the coals burning his feet, eventually falling down into a spasm followed by immobility and silence. He was carried off by 4 men. The entire audience of about 120, having seen so many patients with HIV/AIDS and so many AIDS orphans, was stunned.

The performance preceded our final supper and was held in an outdoor, sandy courtyard at Kumbali, a beautiful lodge outside of Lilongwe. [Madonna appropriates it when she visits Malawi.]  At supper I sat with 5 students, mostly Ethiopian although one woman was from Tanzania and doing her studies at Addis Ababa University. She is a psychiatrist who is getting a PhD and has left her 3 children and husband for a year to go to Addis for the coursework. She’s made a lot of sacrifice but she looked pleased with her choice.  Still, she is a very warm person and missing her children and husband.

I’ve been feeling sad about leaving Malawi. We have enough good friends now and I am learning a lot about the System and how to work within/around it.  I applied for the Fulbright to Myanmar a year ago after hearing a lecture from a population expert that Malawi’s will double by 2034. Since they can barely feed themselves now and the birth rate is down to 4.8 children per household, it seems a recipe for disaster and hopelessness. That is true, but my reaction is now tempered by the disasters in the US and much of the rest of the world in terms of violence, hunger, poverty, sex trade, ivory trade, drug and arms trade, corporate and government greed and corruption, income and opportunity inequality, and so on.  Malawi is beautiful, people are generally non-violent, there are very few guns here, and there is an orchard full of apples and few to no other apple pickers.

I suppose the AMARI Conference made me realize that there are lots of smart and committed people to work and hang around with, even if this landlocked ship looks like it is going to sink.  The world itself appears on the decline and this is not a bad place from which to observe the disasters. Why were we created so that reproduction was so much fun?  Expanding populations make everything worse.

We watched an old film,“What About Bob?”, last night and laughed at the verities therein. It’s great how the family members instantly recognize Bob’s kind, if cloying and unboundaried, nature, which so contrasts with Richard Dreyfus’ character, who is pinched, controlling, and vain.  Even so, the family is able to confront and love him.  It’s a good, light-but-profound 1 hour and 38 minutes.

Linda has been running on fumes for a few weeks, as she clarifies in her blog. Yesterday was the graduation ceremony and jewelry sale of her under-the-mango-tree women’s craft group. They learned to make a wide variety of stunning offerings, as well as how to open a bank account, entrepreneurship, marketing, display of wares, etc. They all dressed for it, visitors came and bought a lot of items, and it was a very sweet time. Linda is donating the materials, the artists’ salaries, and her own time; proceeds from the sales will go to the women to do as they wish. Buying materials so they can do this themselves, and teach others, would be a desired goal but it may be that things are so tight the money must be used for survival only. Some of them walked 2 hours twice per week to come to and go home from the classes. That’s the thing about gifts; people will use them as they want to, just as our kids will do what they want to after they are independent (and often before). It does lighten Linda’s load a bit, however, not to have to run back and forth twice per week between her 1st year nursing students turned loose on the wards at Queens and the crafts group.

We’ll get our Mozambique visas this week, with luck. And get the car back from Eugene Murphy, an Irishman who runs a tight auto maintenance and repair shop out of town. He has a gift of gab and is a wise soul about Malawi after many years here. Quite a find! We’re off to walk to the minibus to get to the road to Peter and Caroline’s for lunch, having no car and rain threatening (dissuading us from biking).  It is a several mile walk through woods and maizefields, which exercise is welcomed by us both.