The warm heart of Africa, Ngodzi, Malawi with Lifeline Malawi

www.lifelinemalawi.com

I remember in the last nights prior to setting off on our journey to Africa, my brother and his wife, Vicki, were helping us pack in the lounge of my parents house, snuggled up by a warm fireplace trying our best to escape the chilly breeze brought in by the surrounding valleys of Cliviger. They gave us a great tip to roll up our clothes before stuffing them into our Macpacs and then sitting on the bags to fit more and more rolled up clothes until it was barely able to zip before popping. This tactic has got us through some pretty tight squeezes up to now in our constant pack, unpack, pack and move on strategy from Ethiopia to Kenya, Tanzania and now Malawi. But the novelty and excitement of packing for each new adventure has sadly come to an end, and now it’s a case of “oh no we don’t have to move again” with the added complication of more and more souvenirs, making packing more of a strategic operation than a pleasure.

So we unpacked again in our spacious mission house in Ngodzi, a tiny remote village on the shore of Lake Malawi, just shy of two hours drive from the country’s capital, Lilongwe. Throughout the day the shore was buzzing with activity with the constant flow of women washing pots, pans and clothes in the waters; (judging by the amount of washing done, they either have very big families or are running some black market laundry services), farm boys herding cattle across the sands, naked kids playing water games together and fisherman preparing their nets alongside hand crafted wooden canoes in anticipation for the days catch. We were shown around the compound and introduced to the staff working their by Chris; an old school, ice cool and charismatic doctor who founded the charity and currently resides in Malawi with his wonderful ex-flight attendant-come-business woman wife Heather, their gifted daughter, Chloe and friendly slobbery dogs; Riley, Biscuit and Charlie. The Ngodzi health clinic, by far the biggest centre we’ve worked at (which isn’t saying that much) comprises of a few departments ranging from family planning, HIV counselling and testing, a 24 hour maternity unit and daily clinics with a dispensing pharmacy offering services which the surrounding village people would never previously have access to. We were to start work the next day, which would prove to be the most demanding and challenging job yet.

0730hrs the next day would begin with prayers followed by orientation and the start of clinics. We entered the waiting area to be shocked by a jaw dropping 300+ people waiting to be seen. I was to join the already established clinic system as an extra doctor, but Hiba was starting a new service for the people; a daily dental clinic. Within a few hours of announcing the service to those waiting, the door leading up to her room had formed a big orderly cue. With extremely limited resources, namely no dental chair, proper lighting or tools she began assessing and treating those with dental complaints. Due to the extent of tooth decay, the majority of cases required extractions, which can be challenging enough in a well equipped setting as it is. She quickly found her feet, began treating patients in a timely manner and ended up doing over fifty tooth extractions in seven full days of work. Hiba’s work was not without its challenges though, and she occasionally found herself struggling with the shear strength of bone or difficulty in root shape, owing partially to the lack of x-ray guidance. So, exhausted and stressed one afternoon, she turned to me to assist her in a difficult tooth extraction. I had never taken a tooth out before and hadn’t the first clue of what was required as it’s something a doctor normally really wouldn’t know. After I had a look at the tooth, an ‘upper right eight’, even I could see it was in desperate need of removing, so I put on my two sets of gloves and proceeded to use those pliers, I mean dental forceps as I followed Hiba’s instructions, firstly loosening the tooth using the elevator, gripping it at the neck of the root with the forceps to begin pushing the tooth in a figure of eight until it began to loosen. I would then twist my hand to pull the tooth out of its socket and before you knew it, in my hand lay a complete, unbroken tooth.
On this Tuesday Twelvth of January Two Thousand and Ten , doctors would finally be given clear and inarguable proof that we are in fact better than dentists, and that we can do their job better than them with the absolute minimal of training or expertise.
My usual work would include extremely busy clinics full of sick people that desperately needed attention. We also attended an outreach clinic in Abraham, a very small and isolated village with no medical facilities nearby. A derelict stone hut was used and my ‘consultation room’, a section of the one and only room separated from the rest by a thin curtain, had just about enough space for me to stretch my hands out in front of me.

On our deserved weekend off, we decided to go fishing in the lake as it seemed silly to be living on a fishing lake, with fishermen all around, with fish as the most abundant meat, and not go fishing! But we were a million miles away from tourist hotspots with companies offering services in spoken English so it would require a little more work to arrange. We strolled down the lake shore with the usual wide eyed stares from everyone as if we were a different species until we came to the area where the fishermen hung around, preparing their nets before heading out on their boats. I approached one of them asking ‘Do you speak English?’ ‘We want to do some fishing’ ‘Can you take us line fishing?’ Met with a familiar expressionless face, we moved on to the next person, and the next until finally we met Isa, a boat-owner who agreed to take us out for 2000 Kwacha, about £9, for two hours. So we went the local mud-hut shop, bought a line and hooks then got some small fish bait. We were ready, but our boat clearly wasn’t as when I asked Isa where the boat was, he pointed downwards at an engine and stated ‘There’. It took another thirty minutes to get the actual wooden boat over and fit the engine to it. Just before we got on Isa said that we had to be back at 5pm as that’s when the fishermen who are using his boat will be leaving, cutting our time short to one and a half hours. Slightly irritated at his cheekiness I expressed my dissatisfaction and we finally agreed to pay 1500 Kwacha, as it was a fair price. Isa brought along three of his friends to drive the boat, help us fish and the third who....just slept. Whilst out on the lake, Hiba managed to catch a tiny little fish which is better than what I managed, but it was all fun nonetheless. On our return to the shore, Isa turns to me and says ‘I need to pay these three men, so pay me for them’. Not sure how to take what he meant I replied, ‘I will pay you the 1500 Kwach as we agreed and you can do what you like with it’. He continued to persist saying that these men have come out with us and should be paid. His nerve finally got to me and I firmly said, ‘Look, don’t even think about trying to cheat us, we agreed 1500, and that’s all you’re getting, so take us to the shore and we’ll sort it out there’. Isa turns to his driver, says something to him in ChiChewa, the engine stops, and silence. We’re out in the middle of one of the largest lakes in Africa with complete strangers who are clearly trying to rob us from our money and we’re pretty much helpless. I feel the adrenaline pump through my veins, my heart thud, a thorn in my throat and my fist begin to tighten as I eye up the three men, judging how I’d take them down if they were to attack. Isa asks again, this time in a more aggressive manner ‘Give me the money to pay them now’. To which I replied ‘I’ll give you the 1500 Kwacha we originally agreed on, but nothing more’. Isa’s eyes suddenly lighten and he says ‘Yes, of course that is all I wanted’. I feel an immense sense of relief coupled with confusion as I turn to Hiba, equally as confused and hand him over the 1500 which he distributes to his colleagues. The engine chuckles into action again and back we go to the shore. Was there really a miscommunication or did he change his mind once he saw me get angry? Either way, we were both glad nothing serious came of it and retired to our mosquito net bed for a good, hot, fan-assisted nights rest before an early start for work the next day.

On our last day in Malawi, I decided to join the theatre list at MUA Mission Hospital, having been invited there after a previous visit of the grounds and departments with Hiba a few days earlier. MUA is a relatively large hospital, to which many smaller clinics refer cases if they require serious or further attention. There is one doctor at the hospital, which is somewhat a novelty as real doctors are very scarce all over Africa as they all seem to leave as soon as they can, and the position of ‘clinical officer’ has been introduced giving people the opportunity to study two to three years and undertake what we would know as the role of a doctor. Their training is by far more limited and this is reflected in their weak knowledge base and although they tend to be proficient in practical matters, I have noticed many bad habits and incorrect methods of doing things. The doctor at MUA had been newly appointed from the Dominican Republic of Congo and took the job on religious grounds due to a conflict in the principles with his old hospital. I was invited to assist in a Caesarean Section in a modest theatre room with a semi-functioning air conditioning system, which would keep you cool if you stood in one specific spot and didn’t move. Unfortunately this spot wasn’t really all that close to the operating table, so I’m not really sure who it was intended for...perhaps the Anaesthetist drinking coffee and reading her newspaper. The Anaesthetist quickly and very efficiently administered a ‘spinal’, so the patient would remain fully awake but not feel anything from her nipples down. The DRC doctor, who qualified five years ago with no specific surgical training, proceeded to run the scalpel from just below her umbilicus about three inches downwards. With more pressure than I’ve ever seen, the scalpel tore through the various layers and a few seconds must have passed before the inevitable happened; he cut an artery. Out sprayed the blood and to my shock he carried on cutting down until he got to the level he desired, where he then carefully began dissecting the finer layers just above the baby’s head until he made a cut, pushed two hands in the uterus and pulled out a [surprisingly living] baby boy which he held dangling by its ankles and passed it to another person who carried out the weight checks etc. At this point there was a lot of blood and after delivering the placenta, he started suturing up his wounds still ignoring the bleeding artery. The lady began to fall pale and weak from the blood loss, some 1000ml so far and we started searching for the arterial bleed. The first one was still bleeding but that was minor as compared to a much larger artery that really was spraying around the room! After five minutes of struggling both arteries were finally tied and the bleeding stopped, allowing us to close the patient up and send her safely to recovery.

Exhausted from shock, I called Maurice, the charities driver, to come and collect me but he stated that he was at another hospital in completely the wrong direction transferring a critically ill patient over there, so Clement, the gifted and intellectual Ngodzi laboratory technician, would have to come on motor bike some thirty to forty minutes and collect me. ‘Ok, no problem’ I said. Only after hanging up the phone did I realise that I just agreed to go on the back of a motorbike home! Everything will be fine, I told myself. Forty-five minutes later, Clement noisily races his way up the bumpy mud-track road in his flame red Euro Trac bike. A take a deep breath and hop on the back. ‘Have you got a helmet?’ is the first thing I ask to be offered a bright red Eighties style paper thin hat with a broken buckle. I resort to tying a knot to securing the helmet in place, which would certainly fly right off the moment I were to fall off the bike. Clement asks ‘Are you nervous’ to which I gingerly chuckle and shout ‘Of course not’. ‘Feel free Marwan’, Clement offers. I inspect the bike to find a speedometer fixed on 76 km/hr, but other than that, everything else appeared to be in order, although I have absolutely no clue about motor bikes. Crying into action, we make our way down the bumpy dirty road at a reasonable pace until we hit the main tarmac road. That wasn’t so bad, I thought. At that moment Clement thrust the bike into a frenzy of speed down the highway, leaving my heart in my mouth as the people on bicycles blurred past. I began to think of the statistics: road traffic accidents are the leading cause of death across Africa; the nearest hospital is MUA with a rookie doctor who probably knows next to nothing about Trauma and Orthopaedics; and my helmet is a piece of junk! I even thought about writing this blog about the experience, if survived, my parents reading it and giving me an earful down the phone the next time we spoke. Just before heading out to Africa my mum took Hiba by the hand and said to her, ‘Look, Marwan is crazy and too adventurous, so don’t let him make you do dangerous things. Keep him in check’. Where was Hiba now to keep me in check?! At least she wasn’t with me, I thought. So that if anything did happen, it would only happen to me and I wouldn’t have her family to worry about as well (!). Having realised my pessimistic mind-set, I shook my head and forced myself to snap out of it; lots of people do this all the time, I thought. I quickly asked Clement if he’d ever had an accident, to which he replied no. Just as I settled into the rhythm, a downpour of rain and heavy wind comes slapping in our faces. The new statistics: road traffic accidents are the leading cause of death across Africa; the nearest hospital is MUA with a rookie doctor who probably knows next to nothing about Trauma and Orthopaedics; my helmet is a piece of junk; and it’s now raining and very windy!!! With whispers of prayer under my breath until we arrived at the Ngodzi medical clinic, I thanked Clement for the ride with a brave face and ran inside to tell Hiba my adrenaline-pumped story!

There’s much more I could write about from our short stay in Malawi, but I’ve written enough and I have an exam to revise for.

We had a fantastic time there and the people really lived up to their hype as being the friendliest people in Africa. The weather was lovely and the country a gem. It really is the warm heart of Africa.

Finally, long live the Malawian state-of-the-art taxis- one man and his bike!