Author: Children Deserve Better

[Above photo:  The tree-house-person drawing by a castrated boy. “The man is going to kill his dog because the dog has been killing the chickens.”]

8 October 2017

Try as I might, I cannot write these posts in a linear fashion, that is, with each entry themed. Sometimes, like today, it is just a random collection of events and reflections, cortical jumble. A more positive spin would be that I am confirming Piaget’s theory of learning: a step-wise progression from the energetic chaos of information-gathering to consolidation, repeated. Glad to think I am still learning. And that I can recall a bit of Piaget, even if perhaps erroneously, from 1977-78 in my Child and Adolescent Fellowship. Of course, long-term memory generally goes last. Now, what was I saying? Ah, yes, a perfect descriptor for our pres (there are so, so many, and so many opportunities he generously gives us!): an ignoranus. That is, a stupid ass-hole. I didn’t coin that, although I’ve appropriated it.

My second dinner party of last weekend was fun, like the first, although the cooking was not up to snuff. I asked Lucy about the onion-rosemary bread; Stefan said it looked wonderful. Lucy, truthfully, said it needed a bit more salt. I confessed I’d felt so successful and smart, making it all in a wok so the kitchen didn’t look like Ruthie’s Run at Aspen after a blizzard, that I forgot the salt and oil. Not bad but not as good as it could have been. And shall be in the future! As Harold’s patient at Neurology Institute in his third year clerkship said to him: “Good mornin’, darlin’ [doctor] Varmus. Every day I’m getting better and wetter and wetter.” Seconds before Stefan honked at the gate, I turned the burner underneath the risotto up to 4, a powerful setting for this range. Between 3 [tepid] and 4 [seventh circle of Hell] is an infinity. It is a Defy, from S. Africa. It does defy attempts to operate it with ease. After greeting them, I noticed a burning odor and smoke from the kitchen and realized the risotto was carbonizing. It was unsalvageable so I had to start again. Truth is, my second attempt was pretty darn good, considering I used sushi rice in place of Arborio, which I cannot find here. I’ll try it again, soon.

Mulanje is off-limits for Peace Corps and all Americans at present because of the violence over the “bloodsuckers”, so I won’t be going there this weekend   The shopkeepers, porters, guides, and pizza-joint owners should calm the people who keep the “bloodsucker” fire stoked, as the tourist trade has dried up. Apparently, rumors of vampire attacks are an old standard in Malawian culture, going back hundreds of years. Of course, it was the British then, and they were extracting what they could. We actually bring money into the economy, as well as expertise, friendship, good will, etc.

I saw a boy in clinic today who was castrated—penis and testicles—7 years ago (at 7yo) and brought to the ED at Queens with the story that he’d been in a motor vehicle accident. He had a few additional scrapes and bruises but no bits and pieces. The story didn’t ring true for the physicians on duty. Currently his uncle is supposedly suing the hospital for castrating his nephew. He’s been started on testosterone injections and is a handsome, bright lad with a tale which he will not currently reveal to anyone. He wisely was taken from his uncle’s custody during his initial hospitalization and is living in an undisclosed location. His mother died 4 months ago and he never knew his father. He drew the most amazingly revealing tree-house-person I’ve seen (above).  And has nightmares weekly of people “trying to kill me so I run away”.  It is almost beyond my comprehension and sadder than anything. Not sure where our therapy journey shall take us, of course, but I shall try to join him and see.  I thought the panga knife attack featured in last week’s blog or the numerous rapes I’ve heard about were the worst I’d see here. My vicarious traumatzation.

Having mentioned my trials at Road Traffic in obtaining the Certificate of Fitness for my car, I’m about to be re-immersed in the sweating, elbowing crowds there. Driving back to town from my consultation with a lively group of social work students and several journalism students at Samaritans, I was pulled over at a random police roadblock. After she examined the recent stickers I’d appended to my window (proof of insurance, COF), the officer asked to see my driver’s license. Slowly examining it she asked how long I’d been in Malawi. “Thirteen months”, I said. “That’s a 10,000 kwatcha fine, payable now. You must have a Malawi driver’s license (not one from Maine) after 3 months living here.” I hadn’t known that. I only had about 5,500 kawatcha ($8). “That’s not enough.” When it was clear I didn’t have the cash, I jokingly said, “What, will you put a professor at the College of Medicine in jail?” Smart ass—-stupid, actually, to mess with the po-po. I gave her 2000MWK, she gave me my license back, and I drove on. I hate to enter so directly into the system of corruption. I must return to Road Traffic next week and “start the process”, as she ominously said. I’ve emailed the US Embassy to ascertain the accuracy of her information.

This week I had to order 3 MRI’s. One for the panga knife attack youth who continues to suffer from daily headaches (He had a subdural hematoma.), one for a 68yo man with a 45year history of daily cannabis use who is wandering aimlessly around a dangerous area [Ndirande] every night and is confused, and one for an elderly woman who is ataxic and increasingly forgetful.  The procedure is worth explicating. I fill out a request form, get my head of department to sign his approval, and take it to the Hospital Director’s secretary, leaving it for a few hours for the Director to sign. [On one of them I had inadvertently neglected to fill in any clinical information. The Hospital Director signed it without question, confirming my suspicion that this is just a pro-forma approval.] Then I retrieve it and walk it over to MRI and arrange for the appointment. Back to clinic to put a top-up on the phone so one of the nurses can call the patient who generally only speaks Chichewa, notifying them of the appointment. Then I must remember a day or two after the appointment to walk to MRI, again, and give them my email address (even though it is requested and written on the form) so they will send me the result. Then I have to arrange for someone to read it, usually in Washington DC or Boston, as we don’t have a regular radiologist here to do it. [Some radiologists aren’t qualified to read them, let alone a child psychiatrist.] Then I must schedule an appointment to see the patient and guardian to share the results. Times 3 for me this week. And the distances aren’t negligible. Queens is a huge hospital, all on the ground level with large courtyards between buildings and very long corridors connecting the latter. The administration building is about as far from the MRI building as you can get on this “campus”, both on opposite edges of the periphery; Room 6, where I work, is midway. Pretty inefficient.

I have a weekend with no social obligations—I’ve been given two invitations but since I thought I’d be out of town I declined each and haven’t renewed—–or work demands.  I managed to get 4 new Pirelli radials on the car yesterday in a miracle of efficiency at the Indian-owned Mapeto Tyre Company, a big slick operation where the tyre installation, balance, and alignment are included in the tyre price. This is noteworthy, as added charges are a staple here; my bank charged me about $15 to deposit $10,000 from which they made money until I used it to buy a car. A spotless shiny white and black Range Rover drove in while I was there. The license plate was “M 1”, the designation of the main north-south highway in Malawi. I assumed it was a legislator. No, no, it is the owner of the company. Would you like to meet him? Sure. We shake hands. He is genial, and why shouldn’t he be; I just dropped 370,000MWK at his shop!  I did talk at length with a young Irish teacher from County Galway who was also getting tyres for his x-trail. He showed me a cardboard box into which he has installed a tiny battery-powered incredibly bright LED projector, with speakers, amplifier, a large lithium battery, solar charge controller, etc. It is a prototype for primary schools as there are various curricula in Chichewa on the net and it is much more efficient and economical to project them on a wall than to buy textbooks for a class of 90. He even had a metal lunchbox fabricated for him in the village into which he’ll fit all the components, protecting it from the elements and making it easy to transport.  Plus the aesthetics.  It all weighs about 15#. Ingenuity!

The guards are seemingly happy and showing up for work regularly. Cabbage had a sore jaw last night and I examined it with a spoon and flashlight. Through broken English and Chichewa I learned that he’d had an extraction two days before and had run out of “prufen”. I have a good supply of ibuprofen from Peace Corps and cannot use it because my kidneys were whacked by my first round of chemotherapy in 2008 so I gave him a several day supply and shall follow the infection. He has a couple of small, hard lymph nodes in the area but no real rubor, turgor, or calor so I think he doesn’t need antibiotics. It’s fun to be a doctor!

I’ve been sleeping very poorly, awakening and reading every two hours or so until I fade out again. I wonder, am curious, and worry about my children—where they are, how they are, who they are becoming. Finally, yesterday morning I wrote to my therapist in Berkeley about it and slept soundly last night. Amazing how effective sharing your stuff is! It’s one of the background themes I stress again and again with the medical students: how much suffering they can ease if they just listen.  When I was working as a Family Physician a young woman tearfully confessed to me that she’d slept with someone after a drunken party while her husband was overseas in the military. Talking about it greatly relieved her and when he returned several months later, she brought him in and they both thanked me for helping her. I doubt that she filled him in on the details, kindly.

The birds are returning and the birdsong is deafening. I am regularly seeing white-browed robin chats. Yesterday I saw a cluster of three mousebirds—they are large and crested, which makes them always look surprised. And their landings are hilarious, crashing into the bushes, making them sway wildly. And a dark-capped bulbul with his bright yellow vent. I’m awaiting the sunbirds, those tiny, brilliantly colored migrants. No roundups and deportations here. Oh, I just saw a blue waxbill at the birdbath, my first in 4 or 5 months. Now, how to get the house sparrows, those very chatty year round little eave-dwellers, from pooping on the wicker couch cushions on the front porch? A diet of rice and cheese? Imodium?

Linda is at her Peace Corps cohort reunion in Savannah, Georgia, birthplace of the martini. I wish I could join them. It is good for me to be alone but I miss her.

[Above photo: The drawing made last year by my then-13yo patient describing his attack by a woman with a panga knife, giving him a subdural hematoma, large lacerations on the scalp, left arm, left thorax, and left tibia, fracturing the latter.  A neighbor rescued him from being killed.  Note the minimal facial details: that is, emotional expression.]

1 October 2017

It has been a busy week and that continues this weekend. I’ve been out to supper with friends every night except Monday, when I had a pre-supper orgy of donuts at the Blantyre Child Study Group meeting. Anna, the school counselor and PE teacher at St. Andrews International Secondary School where we hold our meetings, is an active member of the group and generously arranges for us to all have snack food [samosas/ egg rolls/cookies] and tea supplied for our meetings every two weeks. Oh, I gave a slide presentation on Wednesday for the Malawi Mountain Club members about some of our hikes, walks, and strolls in S. Africa last Christmas, which was preceded by supper at the venue.  The other presenter told a tale of a truly harrowing climb, with ropes and crampons and ice axes and 2 guides and 4 porters, up a 16,000+ foot peak in western Uganda. Wet, dangerous, cold, people die there every year—-I no longer have that need!  Friday night was a very moving concert of Yom Kippur music, performed by four musicians. The violinist, a Family Medicine physician here for many years, is Jewish and put it together. The minor scale is so beautifully evocative of the suffering Jews have endured throughout history, especially in Russia and [eastern] Europe.

I’m having two dinner parties for friends this weekend: one last night and one tonight.  How Linda does this entertaining thing, enjoys it, and makes it look effortless, I’ll never know. Plus, she’s a great cook. I spent yesterday morning in the Blantyre Central Market, getting vegetables and fruit; then I biked to Shoprite at the other end of town to get the rest. Cooked much of the afternoon, when I wasn’t cleaning the house, since Catherine is now banished to being a guard and doing laundry only. She was not a skilled house cleaner, to say the least. Linda thinks it is because no one has taught her. I think it’s because she doesn’t care or pay much attention to where the broom actually goes. I’ve gotten so bad that I’ll see a dead bug or small scrap of paper on the floor, note it in my mind, and see if it is gone after she “cleans”. Never disturbed. Plus, she was making popcorn, spilling it all over and not cleaning it up, and used about a quarter of a bottle of our olive oil.

Last night we had brie with (my) homemade sweet potato chips for appetizer, two roast chickens stuffed with lemons and covered with olive oil, salt, lemon zest and garlic. Roasted tiny potatoes, with thyme and garlic. And a huge salad with all sorts of vegetables, mainly from the garden. And brownies with fresh strawberries and yoghurt, brought by the Carolines, for dessert. Everything, I mean all of it, was eaten. Graham and Caroline brought a friend from UK, Andy, who was “passing through”. Actually, Andy has been on the road for 14 months, cycling from London to Cape Town on a mountain bike. Fit and with a corresponding 6000 cal/day appetite. We had a great time.

Tonight I’ll make a risotto with bacon and mushrooms with a big salad and more strawberries. The uncertainty factor is that I cannot find Arborio rice anywhere. The closest I can get is sushi rice, which is sweet and sticky and I think may work. I thought to mix it with regular long grain rice but they may have differential cooking times which would be problematic. Maybe I’ll rise to make some bread (no pun intended). And, as a finale, dark chocolate while sipping whiskey. Take your choice, Harriers or Conquistador (although I cleverly poured the latter into the empty Strathisla 12yo Single Malt bottle to distract people before the blind tasting I’ve planned.) It is lunchtime, which may account for my focus on food—sounds like a cooking show.

I’m laughing my way through Bill Bryson’s A Walk in the Woods. Next up is Free Country: A Penniless Adventure the Length of Britain by George Masood. He and a friend start at Land’s End in Cornwall in Union Jack boxer shorts only (no shoes, no $), planning to get to John 0’ Groats at the northern tip of Scotland in 3 weeks.  Not sure why these funny and preposterous tales appeal, but they do.

I presented at the first PACHA conference, an all-Malawi organization for anyone working with kids. It was a 3 day affair at a fancy Chinese hotel in Lilongwe. It was a lot of fun and I have great hopes for the organization if they can be truly multidisciplinary and not collapse into hierarchy with physicians at the top. The American Academy of Child and Adolescent Psychiatry is very much a guild organization, which I think is short-sighted and stupid.

I finally got my Certificate of Fitness from Road Traffic and am driving around. I use my bike always, unless it is dark or I’m going a long way and need to be not sweaty at the end because it’s a party and there will be others there.

I’ll try not to rant about DT, though it is difficult for me: the plundering, the lies, the pathetic appointments of ultrawealthy guys and their trophy wives who feel, painfully, the sacrifices they are making for the country and how the latter entitle them to very expensive perks. It is disgusting. I do enjoy the fairly frequent editorials that contrast DT’s quotations on the campaign trail and now, seeing how he has had no intention, really, of helping anyone but himself. Ever. Those who see a clever, larger, more generous intelligence operating behind his lying bluster are sadly wrong.

I am awaiting news from the Fulbright folks about my application to go to SE Asia January 2019. Even as I do, I feel more attached to Malawi and to the new friends I’m making and to our sweet little house and everything. Even though Malawi’s trajectory in the long run appears hopeless to me. The Pediatric Mental Health Clinic expands to two rooms as of tomorrow and there will be medical students in one room and a registrar (resident) in the other, both of whom I’ll mentor.  Also, the three psychiatric nurses from Room 6 will rotate through.  Since they all have raised their own children and are smart, I expect that in 9 months they can oversee a credible quality of service there. Sustainability is everything here

The past 2 weeks have seen major concerns around a rural area southeast of here about people sneaking into villages at night and “bloodsucking”. So much so that a Belgian couple were beaten and 3 Malawians, on another occasion, killed and burned. People are sleeping in the open, forming protection committees in the villages, and even attacking the police, who they think are in cahoots with the “bloodsuckers”.  Peace Corps has evacuated all of their volunteers from the area for now.  It feels a little like Deliverance to me: rural, uneducated, superstitious, frightened, violent. I think as the economy continues to spiral downward in the next 10 years, we’ll see an increase in this sort of thing.

I saw the boy 3 days ago in clinic who made the drawing at the top of this post. He was attacked a year ago by a woman with a panga knife. His mother has gotten him into a private boarding school where he is doing very well. Saved him, she did, demonstrating a mother’s tenacity. They are poor as churchmice, so she must have found a scholarship.

I’m heading up Mulanje with friends next weekend to stay at their cabin. It is, I believe, the only privately-owned cabin on top of the massif. The woman is an acupuncture therapist who is the Child Protection worker in a local private primary school; her husband is the head of Pediatric Surgery at the College of Medicine. Both his parents were physicians here, luminaries really, and he and his siblings were all born here. Sort of medical royalty. They are both fun and smart and generous and I look forward to the trip, wishing Linda were here to join us.

I think it is time to eat and do a bit more shopping for tonight’s supper. People are very kind and look out for me, in Linda’s absence, thinking that I’ll be heating up a can of beans or some such. This morning I had a custard apple, two cups of tea, a fabulous omelet with cheese, chives and chard (from the garden), and a toasted slice of my homemade bread with S African apricot jam. I do OK.

 

[Above photo: The scene of the crime and the instrument in question.]

17 September 2017

It was not really pasturella pestis, rather my (often self-inflicted) version of it.  It started Tuesday.  As I entered Clinic to mentor the students, a young woman patient of mine, a student in the College of Medicine approached me. I’d written a letter supporting her desire to withdraw from school for reasons of her mental health. The letter went to the Dean of Students, with copies to the Registrar and Head of Department on official Queen Elizabeth Central Hospital stationary with officially signed seals. I said, “[X] is a patient of mine. She is unwell and unable to attend school until further notice”.  It was signed with all my titles following.  The young woman was told that the letter was wrong, it was more like a letter from a tutor, not her physician. After unsuccessfully trying to call the COM central switchboard, I told her to wait, got on my bike and rode to the College. I was fuming but recalled my mother saying you get more flies with honey than vinegar so I focused on my breathing and was calm and friendly when I approached the Registrar’s secretary. “There is something wrong with this letter. Can you help me?”  She looked at the letter, looked at me, went into another room (the Registrar’s inner sanctum?), came out and said, “Oh, it’s just fine. No problem.” I thanked her and puzzled about it for a few hours until I realized that the Hospital Director’s secretary had sent it to the Dean of Students, missing a nuance of hierarchy. Probably the Registrar felt slighted.   Forty-five minutes of purgatory for someone’s vanity!

Then I worked like a beaver in clinic, rushing out to grab a quick sandwich so I could get to class on time. I went to our classroom—-the necessary speaker system and powerpoint projector had gone home with the Scots the night before—to find it empty. I desperately tried to locate the equipment, calling and texting both Scot phones but there was no answer or reply. Starting to warm again, I went outside to find one of the Scots coming in; the classroom had been changed. The person assigning the classrooms is quite incompetent, it turns out, and after teaching our students for 3 of their 7 week rotation in Lecture Theatre 1, suddenly another group of students plus instructor were assigned it. They arrived, demanding the room.  The Scots graciously conceded and, luckily, found a different lecture theatre. You get the drift.

Scene switches to Road Traffic, where I am becoming familiar with all the personnel and procedures. I needed to get a Certificate of Fitness. Of me, I asked? Ha ha!  No, the car. But I don’t have the car here. It doesn’t matter, they don’t actually check the car. What?!!! Get in that line there.

Of course, there was no line, simply a crush of 50+ people, jammed like sardines in a small hot room, all pressing forward towards the two uniformed men at computers. Two men for a minute; then one man decamped for an hour lunch break at 3PM. Turns out, he was the one with my form. After an hour, the other man asks me, “Is anyone helping you?” As the only white person I stood out, I suppose. And since he was the only person helping anyone, he knew the answer to his question. So I squeezed up, pressed my left index finger on a sensor, and the Fixer I’d hired to hasten me through the process was given a paper and rushed off to pay the COF fee. The seller, Patrick, and I waited by the empty car inspection area, which had a very long sunken pit you can drive over so a mechanic can inspect the underside of your car, drain the oil, etc. Before hydraulic lifts, I think.  Of course, no one was inspecting anything. [Stefan has a hilarious photo of a car driven so the two left wheels have fallen into the pit! Not inspiring confidence here.] When the Fixer returned, I had to get into the crowd again, repeat the process of being crushed and getting identified by fingerprint, etc. After 55 minutes, the entire computer system crashed because it was overheated, so I couldn’t get my COF that day.

Well, maybe we can get my license plates, I ask. We walk up the street, etc. Meanwhile, I am mindful of the fact that in my rush to get to Maine last summer, I filled out the Peds Mental Health Clinic scheduling book wrong. If you look at the entire year on the screen of your iPhone, the numbers are tiny. I’d scheduled all of September for Friday, not Thursday. Since half the people don’t have phones, I was resigned to working in Peds clinic Friday, thus having 4 clinic days each week in September, not 3. This is a significant burden, given that I am preparing and giving lectures to the Medical Students, the new GHSP Volunteers, and at the first all-Malawi Pediatric and Allied Child Health Association Conference next week on top of all my other duties. Oh, and when I came home I noticed that Catherine had purloined a significant amount of olive oil and the remainder of the other cooking oil on the stove. She’d taken the last banana the day before. And I don’t know what else. The orange-handled scissors are missing, but I may have mislaid them. This is not good. I get that she is hungry but stealing, even food, by our housekeeper who is here alone in the house, is not OK with me.  I’ll move her to an outdoor position [until Linda returns, at least.]

I started to get a grip on myself, made a nice supper, and was settling in last night for a productive weekend when I got a call from the Scots. Want to join us for supper at Bombay? Maddy returns to Edinburgh tomorrow. We leave in 7 minutes. Sure, I have already eaten but I’ll join you for a beer. Rush to change back into nicer clothes, get my headlamp, lock the large padlock on the front door metal grate……oh, jesus, it happened. I was rushing so much I left my keys inside.

Long and short, I had two beers at the restaurant watching them eat tikka masala and saag paneer, then a lot of excellent single malt whiskey and dark chocolate at Stefan and Lucy’s where I would spend the night. We went to bed at 11:20 after a great evening discussing the joys and trials of our work here, through a peat-infused haze. After 4 hours sleep I awoke with a possible solution—-fashion something to snag the keys to the back door. They are on a hook about 8’ from the closest window. [No longer, as I give detailed instructions below on how to break into our house!]  I went back to sleep and awakened at 5:25AM (realizing that the guard would leave at 6 and I’d be locked out of the property. So I jumped up, figured out how to exit and lock their security gate, and jogged the 2+ km home, to find that Bernard had left before 5:45 when I arrived. He and I had a big set-to last week about his unreliability and I said, Yes, he could work 6PM to 6AM instead of 7 to 7, even though it inconvenienced me and left us unguarded for a bit (not really a worry). Ok, he’ll be fired on Sunday evening when he arrives. Maybe I’ll offer Catherine his job; she can be outside of the house, then, and make much more money than she currently does. Even though Chimwemwe tells me night guards are men and women can only be day guards. Ridiculous! I don’t think for a minute the night guards would protect us from determined invaders. She does have children to feed and put to bed, however, which may be an issue for her.

So, finding the gate locked, I went two gates up and entered, surprising the guard. The two houses next door are vacant and being rehabilitated.  They are owned by our landlady. I found a rickety ladder made of sticks and nails in the back, carried it to the wall of our yard, and hopped over. Feeling enthusiastic, I fashioned a snagger out of two old bamboo fence pieces tied together with string. I jammed a curved twig from our avocado tree into the end, stood on my cooking briquette press for a better angle and view, jimmied open the window, propped up the mosquito screen, and carefully, carefully—-if I dropped them on the floor, we’d have to break, and replace, two locks to get in—threaded the twig through the ring and brought the keys home. Then I unlocked it all and was in. What a saga! Feeling triumphant I made a cup of tea and ate the best grapefruit ever.

It’s not easy here, especially if you make trouble for yourself by acting impulsively, as I can do.

A baby sparrow had left its nest in our eaves and was sitting on our front porch yesterday morning, holding very still even as Catherine gently patted it. When I came home last night it was gone. I prefer to think that its mother taught it to fly away rather than that the mongoose ate it. No feathers about, so the former seems more likely. [I suddenly wonder if Catherine took it home to roast!]

It is hatching time for geckos, as well. There are a zillion tiny—I mean less than an inch long and as thin as a kebab skewer—ones, indoors and out. They are compact miracles, as all babies are, their adult potential contained in a miniscule package.  When we think of iPhones as miraculous, they are perhaps 1000 times larger and contain nothing like the complexity of these reptile infants.

I’ll return to Road Traffic Monday after clinic to try to complete my COF (Ha!) and then go to Britam to get insurance. Should I pay $1200/year for comprehensive, which I understand is difficult to collect on  in the event of an actual accident, or should I pay $80/year for 3^rd party and assume the risk? It seems like a no-brainer to me.

PS I did fire Bernard, the guard, for unreliablity. “Ok, I know I’m sacked but can I work Sundays? And I want to be your driver—-here’s my license.” Excellent idea!

[Above photo: At play in the fields of the lord. Impala and wart hogs on the bank of the Shire River, Majete]

10 September 2017

Everything is beginning to blossom here. An immense tree in a neighbor’s yard, the identity of which I couldn’t tell, has declared itself: a jacaranda. It is exploding in purple, filling our front living room window. Days are starting to heat up and it will soon be impossible, or at least unwise, to wear a shirt 3-4 times between washings.  A magnificent—-not sure if she or he knows that—-skink was cruising the back wall yesterday. About 8″ long with a pointy skink nose, black body with dramatic longitudinal orange stripes, and a long irridescent blue tail, it seemed relatively unafraid of me. Our mango trees are blooming like crazy so I’m hoping for a good harvest which is kind of silly, given that Linda bought 45 for about $1.25 at the peak last year. Our stove has a defrosting mode with very low heat and a fan, so I’ll try to dry some when they arrive. BTW, the beef stew of the prior week was serviceable.  My thanks to Alan and Joe for a new, no doubt improved, recipe! I made a mountain of naan and discovered it is fabulous for grilled cheese sandwiches, adding a little hot Indian mango pickle inside.

Last weekend I packed my camping gear and rode in Peter and Caroline’s luxurious Prado to Majete.  We kept our day packs with lunch and water and two volunteers drove the heavy stuff across the park to where we’d camp. Then we hiked there in two groups of ten or so, each led by an armed park guard.  It was a walk, really, about 4-5 hours at a leisurely pace, along the Shire River. In addition to enjoying the cool breeze, we saw a fair bit of game, especially nyala, impala, warthogs, baboons, waterbucks, crocs, and hippos, along the way. It was pleasant to start to know an entirely new group of fun and interesting people in the outdoors. After we arrived at our campsite and set up our tents, we rode on a roof rack for 15 minutes to a tributary, shallow enough to discourage crocodiles.  We couldn’t actually swim, more wading and soaking in the 2′ deep channel and pools, a lovely, refreshing antidote to the dusty hike. We cooked supper over a fire and chatted, generally in three groups—the elders of the Wildlife and Environmental Society of Malawi, the youngsters here after college to do some NGO work or vacation, and my group, 50+ (in my case, +++) folks living and working here. Nothing profound, a bit of concern about Brexit and about Trump, some travel stories (trekking for 2 months in Nepal), and general sizing each other up in a friendly way.  The hike out the next day was easy, punctuated by viewing several kudu carcasses of varied age, the results of lion or leopard kills, skirting a pride of lions with a cub, and sidestepping a single bull elephant who was stomping around. Alone the latter are worriesome, feeling more vulnerable and, thus, more aggressive.

I was invited to a braai (barbecue) last night by Caroline and Graham, whom I met on the Majete Walk. They are volunteers for about 6 months with Beehive, a large social enterprise, religious, and educational NGO (Beehive) from UK with all manner of amazing programs. The founder and main support is a telecom entrepreneur from UK.  What a vision he has had and what has been accomplished in only 10 years!

So yesterday afternoon I set out for Namiwawa on my bike. (I’d bought a used Nissan 4WD x-trail the day before but the paperwork wasn’t complete and I had no insurance so it sits in the driveway.) As I biked through the boma, downtown Blantyre, I heard a lot of loud and drunken shouting from crowds all in the street. Thinking that there was a fight or a demonstration I prepared to hightail it but quickly realized that the Bullets had won in overtime.  Soccer (football) has an enthsiastic fan base here! Getting to the Puma station 15 minutes early, I prepared to text or call Caroline who was going to pick me up. Then I realized I didn’t have her phone #. So I sent an email. No response. [As I carefully re-read our correspondence, we were simply to meet at 5:15, no calls needed. Aak!]  I thought, I’ll just find their home and headed down the road to Chilomoni. Asking pedestrians, minibus drivers, etc., as the kilometers added up I gradually got warmer and warmer until, on a very rough dirt track I found the headquarters of Beehive. One of the gate guards knew Graham and offered to show me the way. Let me say, especially as dusk was falling by then, I would never, ever, have found them on my own. Down dirt tracks so rough we often had to walk—“This is a shortcut”.—we finally arrived at a bucholic compound of small houses, workshops, dormitories, a swimming pool, and a large house for communal eating, all set in a gorgeous, sloped park. Their vegetable gardens are not so successful as the baboons eat everything! And the aquaculture ponds are not being used currently, their champion having decamped.

We gathered, Caroline, Graham, myself and 6 others from Beehive and drank and ate barbecue, and fraternized until late. When it was time to go, I reflected to myself on what interesting tales everyone had. One of the wonderful things about volunteering for an NGO is that they usually feed and house you and living expenses are minimal.  When you return home, not only are you richer for your experiences, your pension has been accumulating and you are wealthier, as well, than when you left.

Capitalism, with its infinite need for growth and consumption, is clearly an incredibly powerful economic engine but, ultimately, because it is indifferent to people and the environment and so difficult to control, it is going to end our stay on this sweet planet. [I’m listening to Yo Yo Ma play a sad and lovely piece by Gabriel Faure, which accentuates my fatalistic outlook at the moment.]

In Pediatric Mental Health Clinic three days ago I saw a 15yo girl from a village who has been passing urine without control for 2 years, leaving her smelling ammoniacal and unable to be in school. Three hospitalizations for investigations have yielded no cause, although one pelvic examination noted that her hymen was not intact. I asked her mother if she had ever wondered if her daughter had been sexually molested. She had wondered that, and someone in a private clinic had told her she had been “spiritually raped”, likely by her grandmother. Strangely, a traditional healer they visited agreed. Asking about family relations, she said that her father loved her the best of all 5 children. My blood ran cold and I referred her to One Stop Center, where she can be evaluated and have counselling for sexual abuse. For two years she has been trying to tell someone in her own way. It is a pretty good protection from unwanted sexual advances. There is apparantly a great need among those who have evaluated her to not think she may have been raped. Why we want to assume that feelings are puny and relatively unimportant in our physical functioning is beyond me. It’s the same in much of the US.

Our path forward with North Korea has been so land-mined by DT it is difficult to know how to proceed. Perceived intention is such an important part of diplomacy, which is just another way of saying human relationships. His bullying, dishonest, and bragging utterances close the door to mutual, thoughtful discussion and highlight how very insecure—and, thus, dangerous—he is. Where is the vengeful god of the Israelites when we need him! A little smiting here, please!

 

 

 

[Above Photo: View up the glacier towards Cabane du Prafleuri. Since we were starting to hike the Haute Route two years ago at this time, here’s a photo from then. We stayed at a hut half-way up the glacier, behind the diagonal rock ridge on the left.]

27 August, 2017

The flight from Boston via DC and Addis to Blantyre was long but complication-free. No lost luggage although one of my large bags, which has faulty locks, came open and a heavy S hook for Linda’s hammock fell out. They do not exist in Blantyre, an importing opportunity.  I sat with two young Ethiopian physicians, an internist and a psychiatrist, from DC to Addis and we exchanged notes. Although I cannot be certain (and Skyband Internet is down so I can’t look it up), I believe that the only Child and Adolescent Psychiatry fellowship in Africa is in Cape Town.  There are 60 psychiatrists in Ethiopia but none child-trained. We now have 4 psychiatrists in Malawi and one is child-trained. Excellent to be toward the head of the pack!

Chileka International Airport (Blantyre) was its usual welcoming self, except this time the Massey-Fergusson tractor pulling the deplaning ramp was white, not red. Not another plane on the ground, in contrast with Logan, Dulles, or even Addis, all of which were bustling. Apparently, if you arrive from Lilongwe at noon, the Joburg flight is on the ground simultaneously. I prefer little airports. Less confusion, shorter walks, more personal.

During my absence the country has turned brown, cool, breezy, and dusty. The rest seems unchanged. And without Linda for companionship plus, my thoughts turn to cooking. I tend, in my impulsive manner, to blast ahead before checking a recipe. Just as I noted in my last post that there are reasons for diapers, recipes, too, have a purpose.

I’m making a beef stew for this week, the first of the academic year, knowing that I’ll be weary by the end of each day. So I braised the meat and cut up the veges, picked some herbs, and put them in a pot and cooked all for 1 ½ hours. All the veges were cooked and I had a nice clear beef-vegetable soup. Damn, where does the brown come from?  Checked the internet—-“mix flour, salt and pepper and coat the beef, then brown it with a little oil.”  Aha! So I fished out all the meat, coated it as written, browned it and returned it to the pot. Brown. But needing some reduction. It’ll be tasty, I’d guess. Labor intensive, though. Let me make a risotto any day. In my next stew I’ll add the veges 30’ before completion so they are crisper.  Any stew or casserole suggestions from readers would be most welcome. I’m all about one dish, or one plus salad, suppers.

All of my sister’s offspring, and many of their friends, are superb techies. When I complained on the island about being unable to stream movies because of geographical licensing issues, I was quickly directed by David Perlin to add a VPN to my desktop. Now it says I’m from Boston when I download a film from Amazon. It doesn’t seem like a crime, since I pay for Prime and am not distributing or showing them to anyone else. Actually, it seems like false advertising (a crime in my book) that Amazon didn’t let me know when I paid for Prime that if I was in Malawi I wouldn’t be able to download most of the movies, including all of the free ones.  So, for now, we’re on speaking terms. I did think “Eye in the Sky”, about the humanitarian, moral, ethical, military, political, etc. ramifications of drone strikes, was gripping. The technology displayed was both thrilling and chilling.

Oh, well, I just tried out my Racquet Zapper, a battery-powered fryer for insects, on a huge wasp that got into the house. ZAP! A loud end to his life. So if THEY send those little insect-sized drones with cameras to try to steal the nuances of my beef stew preparation, LOOK OUT!

I realize how hard I worked when I first began last August, preparing and giving a lot of lectures about psychiatric illnesses I hadn’t seen in years, if ever. The Scots are doing more of the lectures this time and I can focus on role-play exercises with the students and mentoring them in the clinic. Also, as of 2 October the Pediatric Mental Health Clinic shall expand to two rooms with a registrar in one and two medical students in the other, as well as one of the psychiatric nurses. All this is to support it being sustainable in a year which, after basic quality of care, is my focus. I still must prepare for a research presentation—-preliminary data on the clinic—at the College’s research conference in November and to figure out where to submit my paper on Donkin Psychosis. JAMA, with the widest US audience, doesn’t accept case studies. Perhaps Lancet Global or the Malawi Medical Journal, which has a lot of readers in southern Africa, at least. I’ll have to ask Lancet to waive their $5000 publication fee.  Since I am a volunteer living and working in a low-income country, I suspect they will.

I do morning exercises and 15’ of meditation without fail, convinced that each will sustain and build muscles I need. I remain in good health, despite being surrounded by (and containing) many challenges, my age notwithstanding. Five days until 77yo. It is hard for me to believe—a cognitive dissonance—when I am tearing down Kamuzu Highway on my bike, fully loaded with wine and groceries, dodging minibuses and potholes. In the first place, I thought I’d be long dead at a young age, like my father, paternal grandfather and older brother.  Second, if alive I’d expect to be in a rocking chair on a porch. So much for good genes, good friends, good diet, good habits, and good luck!

It kills me how we now find that your blood lipids are better if you eat two eggs 3x/weeks than if you eat none. So many people have been carefully eating egg whites each morning for years!  And taking a statin doesn’t extend anyone’s life who doesn’t have a familial hyperlipidemia, though it certainly lowers your blood lipids. And bacteria, H. pylori, often cause duodenal ulcers. Today’s truths, certainly in Medicine, are tomorrow’s fictions. It’s tough to know what to believe, both in medicine and in the wider world. Disinformation, “fake news” proclamations, a president whose documented frequency of lying is stunning, false promises. The very ground is shifting beneath our feet. It is little wonder that youth have a difficult time setting their life course, unless they just do it unthinkingly. The latter may be the best way. Then just be thoughtful about whatever you decide to do. “Be kind, for everyone you meet is fighting a great battle.”

I’m spinning out of control here. Best to ground myself in the stew at hand.

[Above Photo: Meadow in dawn fog.]

20 August 2017

I’ve neglected my blog this month. I’m not entirely sure why. In part it is that I don’t have the same novelty to write about when on Beach Island as I do when living in Blantyre.  Also, it is that many of my observations relate to family and, thus, are too personal for public space.  Plus, I’m experiencing much more than observing, as befits a vacation for me.

This post is being written in a Travelodge Motel outside of Bangor. We have just returned from the northern tip of the Bay of Fundy in New Brunswick where we drove to see the tides. They are the highest in the world, with a 56 foot [maximum] difference between high and low. Imagine tying your sloop up to the pier at high water, going into town for a meal, and returning to find it hanging 30 feet above the water by two mooring lines. And all the locals guffawing. Shrink into the crowd, await darkness and another high tide, and hope for the best!

July on the island produced an abundance of wild strawberries, those tart, tiny red morsels best eaten lying in the grass with a friend as you chat. I loved Bergman’s “Wild Strawberries” which I first watched in college, shown as one of the films in Eric Erikson’s course “Identity and the Life Cycle”. What a man! What a course! Ken Kenniston [some will know of him] was Erikson’s assistant and Margaret Mead made a dramatic appearance on a crutch fashioned from a tree branch. She showed a film documenting the total unravelling of a complex culture in east Africa within a few years after a group of successful hunter-gatherers were stripped of their traditional lands and moved onto a small, arid plot to farm. I recall a woman going into a hut where her husband sat listlessly on the floor, leaning against the wall, starving to death. She had found a root and was nibbling on it, concealing it from him beneath a bit of cloth. Children nursed until 3yo and then had to find their own food. Are we headed in the same direction, with our loud-mouthed, racist leader? It certainly feels like an unravelling of civil society to me.

As the wild strawberries finished by the middle of July, out came a bumper crop of blueberries. My three domestic highbush blueberry plants, bred for plentiful and large berries, are not doing all that well since I planted them a few years ago, but the little, close-to-the-ground wild ones in our meadow went crazy this year. As they passed, the wild raspberries ripened and, with a short overlap, we had a delicious raspberry/blueberry pie Linda made with Amelia (more later).  Finally, in our last days on the island, as the raspberries were fading, an incredible plentitude of blackberries ripened just behind the cabin. A berry, berry fruitful summer.

The centerpiece of the summer for me was 8 nights on the island with Linda’s two grandchildren, Amelia (4yo) and James (1 1/2yo). They are lovely, sweet children and very much individuals, as all parents and grandparents know.  James was content to throw rocks into the harbor for hours on end; at other times, all he wanted to do was what his big sister was doing. He has an arm, is ambidextrous, and the Red Sox had best save their dollars to offer him a good contract. Amelia has the sharpest eyes and was in determined pursuit of sea glass— “pirate treasure”— and pretty stones. I built them a teepee over which I obsessed. The ropes tying the poles together at the top looked cheesy, so I used thinner, dacron line. That didn’t look authentic, so I drilled holes in the tops of the poles and ran dowels through them. But the dowels I had were too slender for the stresses put upon them. Pondering, I stripped some 12 gauge Romex 3-strand and wired them all. Of course, the Navajo were stone-age and didn’t have copper, let alone 3-strand Romex, but….what the heck!  Then I draped the poles with old sheets and sewed them together with waxed sailors’ twine. It looked great. Linda painted a large butterfly on the front and I drew a pathetic picture of the blue plastic wading pool with the kids in it on another panel. The kids went in the teepee twice, I think; the second time was with Linda when she took a nap in there. It rained one day and the butterfly and, thankfully, my wading pool washed away. But I like the look of a teepee in the front yard and left the poles up for next year.

It was pretty exhausting, caring for them and keeping them safe and I was only the sous chef. At points I would find myself arguing over certain facts with Amelia—“The crab is dead. It’s safe to touch it.” “No, it isn’t. It’s just asleep and waiting for its family to come home.” “Yes, it is. You can see because I can pull off its legs and it doesn’t move.” Now crying, “Don’t do that. Its mommy will be very upset.” I realized how regressed and controlling I became when tired. Arguing with a 4year old? We mostly had a lot of fun and I eventually approached being a ‘good enough’ surrogate parent, letting minor crises pass. Like when Amelia cried out from the wading pool, “James just pooped in the pool.” Sure enough, he had. Wanting to conserve diapers, we let him run naked much of the time. You learn what diapers are for when you are examining shells with him on the porch and notice a characteristic odor and, upon closer inspection, a brown lump in the corner. This happened frequently enough that—-no, we didn’t clothe him—it seemed like no big deal.

The island is a perfect place for children. They can run and run and run. When older they can swim and row and paddle, as well. And build—boats, forts. They sleep like logs. Of course, we wouldn’t know if they didn’t, since we became insensibly unconscious by the end of the day and a gin and tonic each.

Island politics are complex and, while not rivalling the Borgias, have their moments. It is generally difficult to break into an established group in any setting. And it is not different there, especially when the newcomer, Linda in this case, is my partner and I’ve recently completed a divorce from someone who has had her own relationships with everyone for many years. I understand it, the need to find wrong, to take sides, etc. but it makes it unpleasant for Linda and stressful for our relationship. Thankfully, some were very welcoming, some guardedly welcoming, and some pretty neutral. All the friends and guests, devoid of knowledge of our rich and bittersweet history (I think of it as dark chocolate.), are warm and friendly. Kind of like the neighbor’s golden retriever. Lacking some situational intelligence but of such an overwhelmingly caring temperament that it doesn’t matter.

Linda was there with me, without grandchildren, for only a few days but, after ironing out some wrinkles, we had a fine time cooking, socializing, and paddling the kayaks. We even squeezed in a sail on my niece Deirdre’s Solstice, a very beautiful and capable, if ancient, Danish Folkboat. As my brother, Chas, says, “It’s like sailing a violin.”, referring to the perfectly varnished mahogany hull.

Chas and I worked like beavers demolishing and re-doing his porch. We always work well together, sharing ideas and skills, and the job turned out nicely. The only sour note was that I got on my high horse and reamed him out for not thinking like I do about climate change, health care, and politics in general. It was bad behavior on my part and I’ve both apologized to him and attempted to understand my passion. His is only one vote, unlike the Koch brothers’, and in our land he should be free to think and vote as he wants without his younger brother giving him grief about it. He is a kind person, even if we disagree. After our father died (I was 9, he 12yo) I looked to him, unfairly, as my protector, which function he served admirably. So, feeling the threat of a drunken idiot at our helm and seeing, still, the growing inequality for the poor, I react and blame him, just as we ridiculously blamed our parents for not being more politically active in order to prevent the threat of nuclear war. I can only imagine what my kids are thinking about me, given the state of our country!

I leave for Malawi at 6AM tomorrow, 22 hours off.

26 July 2017

[Above photo: View from our porch of the Meadow, Farmhouse, and the Harbor]

I just submitted my Fulbright application, which contains a wish to teach Psychiatry somewhere in Asia, in the following preferential order: Myanmar, Vietnam, Indonesia, India. I think of the last as having significantly more medical education infrastructure than the first three, and so hadn’t considered it until I saw positions possibly available.  When I was teaching part of a course in Vietnam in 2004, I was astounded at the low level of psychiatric education and practice. I suspect it is much better now, 13 years later. The people we met were bright and hardworking; they just didn’t have the training programs necessary to learn the discipline. At the National Institute of Mental Health Hospital in Hanoi, a young doctor showed us around. In one room a young woman lay on her bed curled in fetal position facing the wall, immobile. Her mother sat on the side of the bed, likewise silent and immobile, looking at the floor. I asked the doctor what was the diagnosis? He, too, wrung his hands, looked down sadly, and said, “ADHD”. I almost fell down. So, finding the culture, the history, the food, the novelty, and the people of SE Asia to my liking, I want to give it a try. The languages are another kettle of fish, however.

Completing the application had its challenges. The postal code at my home in Blantyre, Malawi is 3. The online application required a 9-digit zip code or I couldn’t submit it. Finally, I just put in my brother’s zip code from Brunswick, ME. I suspect the Fulbright folks, if they take my application seriously, will contact me by email, not snail mail. The subtext of that kerfuffle is that the scholarships are designed to be given to academics at institutions in the US, to which the grantee will return and where their experience will enrich their teaching. I hope to do the same at a college on Mount Desert Island, but I’m not based there at present, not yet having settled here. We’ll see if my application is successful.

The Wasp Chronicles continue. I was measuring my brother’s porch this evening so I could order some lumber tomorrow to replace the floor with him when he arrives on Saturday.  After measuring it all, I was aware of an all too familiar buzzing overhead. Sure enough, a huge nest was hanging from the rafters just above me. Luckily wasps cannot read minds, as I immediately realized I’d have to go back in the cold and dark, when they are cozied up together, and blast them. We’ll never be able to demolish and replace the floor if they are still there.

My cousin Jim is about 50yo, I’d guess. He began lobstering at 15yo and simultaneously knitting bait bags and lobster trap heads for himself and, later, commercially. It isnt his primary source of income as it pays very meagerly,  but it is meditative and satifying.  He demonstrated for me how he does it. The trap makers give him, say, 12 balls of heavy polydacron line. Jim has a setup with hooks and shuttles and a wooden guide around which to knit, which keeps everything even. He can only do it an hour a day or he gets carpal-tunnel syndrome.  After he uses up all the yarn, he returns to the trap company with the knit heads and they pay him by the number of balls of yarn he’s used. The heads can be machine-made but many lobstermen are willing to pay more to get hand-knits. Jim is quick, nimble, and exacting, which his size and demeanor belie. His mind is quick but he, in Maine fashion, doesn’t advertise it so it is pleasantly surprising to watch him put these together. Like hearing for the first time someone singing and realizing what a good voice they have. Old-time skills are preserved, thankfully, by such as him.

Bulletin from The Water Department: Turbidity Reigns.  I noticed that the well was gradually silting in and there were leaves lying on the bottom, as well. Nephew Rob agreed we should deepen it.  I planned to don my wet suit and booties and drop down into it with a bucket on a rope. He had other, far better plans.  I found him in the barn drilling holes in the handle of an old saucepan which he then screwed to the handle of a homemade canoe paddle. We took turns leaning over and scooping out sand, gravel, and leaves and lowered the floor of the well by 6 inches. We left it turbid and I put a note on the pump generator, optimistically saying not to pump for 3 hours to allow the turbidity to settle. Thirty hours later it was still turbid. Someone in our group of gaffers gathered at the well-head had the bright idea of pumping the water out of the well, spraying it into the bushes using a relief faucet, and letting it refill normally (crystalline). We did and it (was). Problem resolved. There must have been a lot of small particles of clay or dirt in there, like all the trashy small-minded self-serving agendas in our Congress. Wish we could just flush them out and start afresh. I’m waiting to see someone try to use the modified paddle in a kayak!

I just finished Mark Richard’s House of Prayer No. 2, which is a terrific read even if it makes me feel like my life is cautious and boring. It is solitary here now, with my sister and her son, Rob, gone; she’s returning to Cape Town to be with her daughter and family. We were having supper up the hill last night with Anadine and she had made my sister a birthday cake. 88yo. We sang to her and suddenly she was weeping and looked vulnerable, like a little girl, feeling loved and so wanting to feel that and surprised and slightly embarrassed by it. It was very touching for me, especially because it’s what all of us want if we are honest enough to risk knowing it. Even DT. Anyway, I was trying to say that now being alone for a bit is nice in many ways, not lonely, and food stretches. [Brother] Chas left two steaks when he was here over the 4^th. I grilled them and one fed three of us a few nights ago. I’ve had two meals from the second and there are probably two meals left on it. But if I were eating in a restaurant, I would have eaten a whole steak at one sitting. Why, I wonder?

On a lighter note, I decided to hold a blind Scotch whiskey tasting after supper and birthday cake. Three of us were blind. I could see but needed to pour and joined in the tasting.  In one corner we have 12 year aged Bruichladdich (Est. 1881) Rocks, “an unpeated Islay single malt whiskey of elegance and sophistication. Bruichladdich alone uses water that has filtered through 1,800 million year old gneiss rocks—the oldest rocks in the whiskey world.” About $80/bottle at Liquor Barn.  In the other corner we have Scoresby, “Very Rare blended Scotch whiskey. This delightful blend of selected light-bodied whiskies possesses mellowness to please the exacting taste of the connoisseur. Aged for 30 months. Drink Responsibly”. About $8 a bottle wherever fine beverages are sold.  The outcome of the contest—-you guessed it. Scoresby was the winner, unanimously! It just shows—something. That Scots can market. That drinking either of them to excess can make you vomit. That both dull your sexual performance equally. That we are not a discriminating group of sippers. I wish I’d brought from Malawi for the contest a bottle of Harriers Scotch Whiskey, complete with an English setter romping across the bucolic label. Trouble is, nowhere on the bottle does it say where it is made or by whom distributed. At $6/bottle it costs 1/3 more than Malawi gin but you may go blind as well, accounting for the premium price. I’m actually not much of a drinker and sleep better without, despite your assumptions from the above discussion.

At her request, I’ve packed my ex-wife’s effects here in boxes and bags.  [I offered to buy out her interest in our cabin so we wouldn’t have to argue over the details of sharing it; she accepted.]  I’ve carried them all into the barn loft where they’ll be safe and dry and clean until I can no longer come here and she’ll return with the kids who shall inherit it. What a sadness this has been. The cabin is rife with ghosts.

The difficulty with a blog is that it is so public.  Sometimes I want to write very personal feelings that really aren’t appropriate for a public forum. Which is by way of saying I hope this isn’t too dull, because I’m aware I’m pulling my punches at times.

My life is set to improve manifold as Linda leaves Malawi in a day. She is soaring, with advancing projects there and speaking engagements here. She works hard and smart and is a poster child for the success that can accrue with loving industry.

[Above Photo: Meadow and harbor at sunrise ]

16 July 2017

It feels a little strange to “visit home”, rather than to live at home and visit somewhere away. But it is lovely here and feels like a comfortable shirt. Today Harold and I took a double kayak around the island and then, feeling no pain, around Colt’s Head and around the Barred Islands. On our way we were observed by 10 or so curious seals, saw several dolphin, and witnessed the local bald eagle and an immature offspring sitting on Colt’s Head, then flying off to the Barreds.  We are catching up on family and careers and, as always, Harold has amazing [true] tales of accomplishments and people he has met or knows. At his level (Nobel Prize, etc) a lot of people seek your advice. He was recently in India, talking with Prime Minister Modi about the direction of Science in India. I miss Connie his wife, who visits and usually returns from a harbor swim each morning when I arise; the harbor is about 58 degrees. Wild horses and a squad of Marines couldn’t get me in there, then!

Beach Island is not without its misadventures. I needed to pump our water tanks an hour ago and after running a bit, the generator died. Assuming it was out of gas, I went to the flammables shed to be greeted by—-a swarm of wasps! Yikes! I shut the door and went to the house, putting on long pants, a long shirt, socks and shoes, a cap and a Bug Baffler. The latter is a parka, with a hood enclosing your face, made of mosquito netting. I grabbed the can of wasp spray, which advertises it will get them at 23 feet and returned to the flammables shed. Indeed, there was a grapefruit-sized nest hanging in the middle of the roof. One blast and they were done. I grabbed the gas can, returned to the generator and found the tank full. Puzzled, I remembered suddenly that we now turn the fuel valve off after we use it. I turned it on and pumped.

I’m quite the wasp killer. Two days ago at 5AM I was awakened by what sounded like a motor in the back meadow. Sitting up with my glasses now on, I could see a large swarm of wasps/hornets outside my window. I peeked out the door, saw a nest, employed my spray can, and concluded that chapter.

Four days ago my niece, Deirdre, ran in the house breathless: “Your boat is sinking.” What!? Chas and I drove out in it 6 days before; it ran perfectly and took the seas kindly. It has been sitting on the mooring since then. There was a moderate blow from the NW the prior night with choppy seas and possibly the transom, with 350+# of Yamaha outboard on it, dipped in, took water, was then heavier and took on more. As I sprinted—well, jogged fast—toward the dock, I saw her down in the stern, then suddenly flip over. Turned turtle, as they say. That name, Turtle, may stick. After some thinking and planning we towed her to the beach, keeping her offshore enough not to bang on the ground. Six of us, donned in wetsuits, stood up to our necks in water and using timbers from the barn, levered her right side up. Then we heaved her to the beach, bailed her out, and put her on the mooring, but not before I removed the engine cowling and sloshed 20 gallons of fresh water over the engine.  I towed her in to South Brooksville shortly thereafter and the next morning assisted in putting her on a trailer to be taken to Condon’s Boat Yard. [Of the same Condons mentioned in the Robert McCloskey story “One Morning in Maine”.] To console myself for the possible demise of our new (used) engine, I had supper at Bucks, the terrific restaurant run by Jonathon Chase in SB; simply the best pork chop I’ve ever had, washed down with a Guinness.

As freighted as the island is with memories, some good and some painful, it is lovely and so special for me. I’d love to bring some of our friends from Malawi here; it would seem exotic to them. To think of Maine as exotic is an unusual stretch.  Certainly being bitten by our mosquitoes and not needing to fear malaria would be a treat!

My guard is down here. I feel I could winter over, though I’d be a strange critter by Spring, since Linda wouldn’t want to stay the whole time and that much listening only to my own gears grinding could be tiring, at least. We are social creatures and although I am OK being alone for a few weeks, I do better grounding myself at times with others, not to mention the pleasure of it. Which reminds me, our friends Joe and Alan welcomed me back so wonderfully with a lovely lunch on their porch and a tour of two cottages owned and for sale by their friends.  And it was so good to see Steve at Mystery Cove Bookstore in Hull’s Cove. There are many such good and interesting people here and, while my Berkeley friends will always be so, I am much less concerned about making a new set here than I was previously. When I finally settle down.

A goldfinch just landed on my birdfeeder. They are hungry little devils and go through two cups of birdseed in a few hours. A baby hummingbird has found my feeder and is coming again and again to drink.  Birdsong all around. I made a wonderful Sally Schneider (Google the recipe.) ancho chile/cocoa/cumin rub for a pork shoulder I now have seasoning in the fridge overnight; slow-cooked it is beyond belief.  I’ll make a risotto with some smoked sausage Harold brought for tonight’s supper. I sent the book review off. I’m starting to relax, not so easy for me. And Deirdre is graciously leaving her very beautiful wooden Folkboat for me to sail. Nephew David and his wife, Kir, have two sets of friends here this week, each with children and all of whom I really enjoy.  It is such an accident that we “own” the island; it is so nice to share it with others who love it as well. Kids, of course, are crazy about it; the freedom, the novelty, shooting bottles in the water to make, several years later, sea glass or “pirate treasure”, as we call it. Fishing, boating, swimming, safety. How it should be. If your young child is gone for 4 hours in Berkeley or Blantyre, you worry they are raped or killed.  Here, you know they have a life jacket on if they are on the dock or in a boat and you know that wherever they are, someone will feed them lunch.

I was so very proud of how every islander rose to the capsizing of the boat and contributed. Everything from driving the tow boat to holding the boat steady to heaving it over to bailing and pumping it to recording it all with a camera and to bringing hot tea to those in the water…..no one was injured, we learned a ton, and maybe the engine is salvageable.  My kind of crew. It recalled to me the immense coming together of sane voices and opposition after DT was elected and began to show his stuff, a capsize if ever there was one. And the resistance, humane and concerned for our citizens, our country, and the world,  shall continue as needed.

[Above Photo:  Sunset from the porch.]

1 July 2017

It took 28 hours from the time I ascended the stairs onto Ethiopian Airlines Flight 877 in Blantyre, changing planes in Addis, refueling in Dublin, and changing again in DC, until I finally deplaned in Boston. Linda’s daughter, Rachael, met me at Logan and drove me to her home in Littleton, where I was able to see Kyle and hold their two children, Amelia and James. They are wonders, as all children are; relentlessly learning, trying, reaching. Two of the chickens, out of the coop, were roosting in a lilac bush. New windows in the house. I wound down quickly after supper and slept deeply.

Now I’m on the ferry, returning from two nights with Jeff and Bonnie in their new home on Martha’s Vineyard. It was built by a dentist who lived there from retirement until 91yo and has wonderful clean lines (He was a dentist, after all.), large rooms, and sits in the midst of an 8 acre oak forest. The large porch has a table and chairs, a grill, a hammock, and an amazing top-of-the-line aluminum ping pong table, a fully-outfitted porch.  Jeff and I tried to recover our youthful ping pong chops with lots of pleasure and little success. It suggests to me that success may not be all that important. We all talked a lot about mortality—Jeff is two years my senior and he’s lost three close friends this Spring, one brilliant college professor to dementia and two who died quite suddenly. I think my sleep deprivation from the flight and the scrambling of my internal clock by changing time zones (6 hours) contributed to my morbid concerns.

It is thick fog in the channel between The Vineyard and Woods Hole, and the ferry toots its path clear. I’ll drive to Boston to visit Zach (Linda’s 3^rd born) at Short Path Distillery in Everett—manufactory of the world’s best gin—and on to see my brother and his wife in Brunswick. Tomorrow I’ll head for Blue Hill to see more family, including my nephew Rob and 87yo sister, just in from Cape Town, before heading for Beach Island on Tuesday, Independence Day.  I hope it isn’t a foggy July; sometimes we get soaked in pea soup for weeks. It is, of course, beautiful and a time for visiting the other cottages and drinking endless cups of tea while catching up.

I worry it may be painful, since Beach Island was the summer focus for my family for many years and my children haven’t wanted to see me in two and one-half years. But other family is there, it is spectacularly pristine and lovely, and I have a lot of thinking and writing to do.

I always leave the island in improved condition, all the walking, lifting, carrying, rowing, and paddling strengthen my physical state and mental clarity. I continue to marvel at my good fortune, dodging the sure aim of metastatic lung cancer.  I have lived so much since its discovery in 2008; the cancer treatment, its recurrence and further treatment contributed to a significant part of my learning.

The ferry is about to land.

The shuttle bus ride is filled with holiday pleasure-seekers of the largely white, overweight American variety. They seem jolly, in general, including the lady across from me holding her 3yo daughter, the latter whose voice has that pleading rise at the end of each sentence: “I want to drive the bus.” “I want some ice cream.” I might just take her to speech therapy, it is so irritating to hear; better yet, regularly engage her in conversations where she feels listened to and she learns a bit about listening to others. It sounds so Valley Girl unentitled, the plea, and will prevent her from landing that excellent job she craves if it persists.

Short Path Distillery in Everett is a marvel. Now 2yo, it has expanded it’s range of standard products—-Gin, Summer Gin, Triple Sec, Light Rum, Dark Rum, Ouzo—and special one-off runs—Blueberry Gin, and so forth. They recently bought a new copper pot still, an immense stainless steel mash fermenter, and have engaged a cooper to make barrels for their anticipated single malt whiskey. The distillery has trebled its space, both distilling and tasting room areas.  Bottle sales are shooting up; an increase of “only” 210% this May compared with the previous year was “a disappointment”!  Zach is, as always, friendly and welcoming and deservedly proud of the operation. Drop by the website and, if you are in the vicinity, by the distillery for a tour, a tasting, and a good time.

On to Brunswick, the home of Bowdoin College and my brother and his wife. Chas and Susan are steady; one can count on them being there. Our snazzy new-used boat (40mph) is in the driveway on a trailer, and we have wonderful grilled Atlantic salmon for supper. Catching up goes on for a long time. In the morning I’m off for Downeast Maine.

My nephew Rob has a very lovely summer place set on a couple of acres overlooking a 2 ½ mile tidal salt pond outside of Blue Hill. The house is large and comfortable, with lots of wood and many windows.  The view through the trees of the tidal bore rushing through the narrow inlet, creating “Blue Hill Falls”,  is directly in front of them.

Amazingly, the 2.3 acres with 400+ feet of beachfront that is adjacent to their property is for sale and the price has halved in 2 years.  Apparently, the land and housing market have not recovered yet from 2008. I’ve walked the property three times and shall again today. I’ll meet with a realtor and look at other properties here in Blue Hill and on Mount Desert Island—which is considerably more expensive—so I don’t purchase it impulsively. But after kayaking about 2/3 of the length of the pond yesterday, seeing the beauty and wildlife, and thinking about the view and proximity to family, as well as the price, I am strongly drawn to this.  I may want to put a modest house with nice touches on the property after I return from Africa. It fulfills my dream of a view, privacy, excellent neighbors, and water access near-perfectly.  It feels moderately rootless to have as a home only a summer cabin on an island, as beckoning as it is, or a rental in Africa. It’s all habit, though; we didn’t start this human journey each owning our own dwellings!

Family traits persist. As different as I feel I am from my sister and my brother, I see tendencies in myself and similarities with each of them which trouble me. A need to be at the center of attention, a readiness to suspicion, a pervasive sense of guilt, hesitation about asking directly for what one wants, a sense of unworthiness. For some reason, I am fatigued with looking to my past for explanations and I just want to practice changing myself. Action!  Linda, you’ve peeled the scales off my eyes!

After visiting several properties today on the Blue Hill peninsula, tomorrow I’ll meet with a realtor on Mount Desert Island to see a few. Today I saw glorious acreage sloping gradually to salt water beaches, but they were generally too isolated for me or I didn’t like the houses. The next day I’ll head out to Beach Island, which I am missing mightily, with my brother in our new, speedy boat.

I hope next Sunday’s blog will be more stimulating!

 

[Above photo:  Looking across the Shire River from Mangochi. Walking by the water is encouraged by the crocodiles.]

25 June 2017

Stefan and I headed down the escarpment and north 3 hours toward the Lake at 5AM last Monday to spend 3 days in Mangochi, previously described in this blog (Recall mosquitoes, crocodiles, falciparum malaria, power and water outages and abysmal dining out). Our plan was to work in situ with the Family Medicine Registrars. The road from Liwonde to Mangochi is an hour of deep potholes and detours, hopefully with road improvements planned.  Pity the cars and minibuses that negotiate it regularly.  We found the College of Medicine hostel on the Mangochi District Hospital grounds and each were given a nice room with an “en suite” bathroom.

Then we entered the hospital to join the morning report/handoff.  5 deaths a day average for this hospital of 250 beds! A post-menapausal woman came to the ED with a history of several months of vaginal bleeding. Her hemoglobin was 2.6 (“normal” is 12.5-14.5). Because she had bled out slowly, she could still walk and do her household chores, although at a slower pace than usual. Privacy for a pelvic examination is difficult to come by so they didn’t do one. An ultrasound (very quick and easy with a handheld unit) revealed a large uterine mass, felt to be a fibroid tumor. She was scheduled for a hysterectomy the following day. Fortunately for all concerned, the intern felt uneasy and did perform a pelvic examination. Lo and behold, she had stage 4 cancer of the cervix. Cancel the surgery, call in the palliative care folks, and tell her family she is going to die soon.

We then supervised the registrars while they interviewed several psychiatric inpatients and a woman on the medical service with a likely post-partem psychosis.  The registrars performed well, carefully and kindly gathering data and intelligently formulating a diagnosis and management plan. The psychiatry “wards” were a sight to behold. The two small concrete rooms, one for men and another for women, had doors opening to a dirt courtyard.  They had mattresses on the floor. The beds had been removed, we were told, as there really was no room for beds.  Beds also made containing aggressive patients difficult and dangerous. The patients generally spend the day sitting in the dirt outside, sometimes dragging their mattresses out.  Since their courtyard is contiguous with the remainder of the hospital grounds, patients frequently abscond. (A good British word, “abscond”. Like “invigilate”, as in “to supervise an examination”.)

We conducted interviews with and discussions of each patient sitting in a circle on small plastic stools in the shade of the solitary tree in the courtyard. There was a lot of activity around us: one young man with probable hebephrenic schizophrenia was trying to make sense of his world by picking up bits of trash and putting them in a plastic bottle. At times he’d join our interview with another patient, then wander off to pee in the dirt or to wash his hands and get a cup of water from the gray water draining from one of the adjacent wards. The cup of water he placed on a branch of the tree, presumably for future consumption. Oh, I should mention that all the patients are on what Stefan branded “Drug Regimen A”—chlorpromazine (Thorazine) 200mg initially, then 100mg twice per day. And diazepam (Valium) 20mg initially and then 20mg twice per day. They were generally stuperous, appearing drunk and dazed if they could be brought to see us at all. If someone is manic or otherwise psychotic and agitated, starting on those drugs at that dosage might be OK, but to continue it makes for a very quiet, sleepy populace.  And one size fits all? Hmm.

Remember the great quests of legend: Jason and the Golden Fleece, Aeneas seeking a homeland, the Odyssey?  Trying to find breakfast each morning was a challenge. I asked at Chicken Line, le centre du haute cuisine de Mangochi, after supper the first evening if they had eggs, coffee, chips, and sausage for breakfast, reading them off the menu. “Yes”, I was assured. When does the restaurant open. “6AM”. At 6:30 the following morning we decided to play it safe and so returned there for breakfast. It turns out they have a breakfast menu, but no breakfast. I should have guessed from the absent main supper items the previous night —no chicken, no beef, no chambo— that the larder wasn’t exactly full. We had tea and Stefan went to the Puma station next door where he’d seen muffins for sale last night. “Not in yet”.  Still, “The Vow”, an English-dubbed Indian soap opera blaring on the TV was compelling. An incredibly intricate plot enacted by stiff, primly coiffed actors and actresses: “That isn’t my real name. I haven’t told you my history.” “It doesn’t matter. I love you and want to spend the rest of my life with you.” “I hope Adak recovers from the accident.” “I do as well.” “If he doesn’t I’ll scratch your eyes out and cut your tongue off.” A tiny sampling.

As satisfying as the soap opera was, it didn’t fill the stomach. Driving back toward the hospital, we turned down a street of tiny ramshackle shops and stopped in front of Dango, a small thatched-roof spot.  Yes, they had rice porridge and coffee. When it came, the porridge was good and smoky, if at times a little gritty. Well-cooked rice and ground nut meal were tasty and welcome.  But the “coffee” was 6.7 parts chicory, 5 parts coffee, 1 part dextrose, etc. 1500MWK per cup!! I can order a full French press of excellent Mzuzu coffee with hot milk sitting in the lovely park at La Caverna in Blantyre for 800MWK.

Still, the porridge stuck to our ribs and, if caffeine deprived, we were ready for a morning of work.  The following morning, ever hopeful, we returned to Dango to find, “No, the porridge won’t be ready for an hour”.  Despairing but beginning to laugh uncontrollably at our misfortune, we returned to Chicken Line, as we’d been assured breakfast would await us today. Nope, we just sprayed the entire kitchen for cockroaches so unless you are insensitive to neurotoxins in your scrambled eggs you’d better pass.

Back to the Puma gas station next door. Muffins aplenty. And a strange-looking drink, Mlambe, made from baobab tree fruit. Loaded, we headed across the street to find some coffee. No coffee, but a nice pot of tea. And an unforgettable menu. Under the Pizza section, Hot Mexican Large. Not so hungry.  If I must eat a Mexican, can you make it a small one?  Another memorable item read, “Goat offals rolled around intestines, fried and locally boiled with small seasoning.” I am so glad that they didn’t boil them over the border in Mozambique and bring them to us. Nothing worse than cold fried/boiled goat offals rolled round intenstine, and so forth.

The registrars had medical clinics this morning, so we returned to the psychiatry service, seeking the new psychiatry Head Nurse. After interviewing the sister of yet another overly sedated patient, we tried to see if the nurse and her staff were interested in talking with us about anything. It turns out, she really wasn’t, except to let us know that she wasn’t interested in doing outreach at the district clinics unless she got an increased allowance. Certainly, her priorities were driven neither by curiosity nor quality of care. Understandable, perhaps, but disheartening.

Feeling somewhat defeated, we then sought coffee back at Chicken Line, hoping their supply truck had come in. Nope, the waitress told us, “No coffee”. “Where in town might we find coffee?” She looked puzzled and turned to ask her boss. He jumped up, found some Mzuzu coffee and made us a pot. It matters who you ask. I wonder if he could have found eggs and sausages the day before. Now we were treated to a Nigerian soap opera on the TV with a lot of very large people screaming at and assaulting each other, men and women. “It was 2000! You agreed on 2000!” A lot of high-expressed emotion.

We did again meet with the registrars and interviewed the existing patients some more. We had noticed on the previous day that the woman with a post-partum psychosis had dark, dark brown urine collecting from her catheter . Since her elder sister was in charge of her fluid intake, we gathered the nurses and sister and emphasized the need for pale yellow urine. Today, to our relief, it was pale yellow; they had given her enough fluids and she hadn’t gone into renal shutdown. Pretty basic medicine. We said goodbye to the registrars, encouraged them to contact us whenever they had psychiatric questions, and had lunch at Golden Dish (not so bad, if slow) with Aye, one of our GHSP Family Medicine doctors who was leaving for the US the next day. I must admire the 4 volunteers who were stationed there for the year; Blantyre seems like San Francisco or New York, comparatively.

By my conventional terms, the town of Mangochi is a wasteland. Yet if you gave up on eating out and any sort of nightlife, I can imagine working at the hospital to attempt to improve things could be fun. Almost anything you did would save a life or improve services dramatically. I guess entertainment could be found on TV: football (soccer) and Indian/Nigerian soap operas. Almost as entertaining, without the fear, disgust, and astonishment, as watching the DT Team attempting to shred our democratic institutions.