Adam Hill's Blog: Welcome to Malawi

So it turns out we definitely aren’t living where Lisa and Richard were last year. Since Dr Kalua is gone to a conference in Argentina for our first week, he didn’t want us living on our own at the guest house, so we’re staying with the random host family at least until he’s back. Hopefully they let us stay when he returns — the food is much better (the mum is a chef) and it’s nice having people to stay with. They’re taking us up to Zomba this weekend because they have a wedding to go to, so we get to see more of the country. Dr Kalua’s back today, supposedly, so we’ll see what happens.

The hospital is much less exciting than we’d hoped, so far. I think part of it is that somebody else here basically got “stuck” with us for the week, and they seem less than thrilled with the idea. So far, we’ve spent most of our time sitting in the library and waiting for something to do, and reading the ridiculous books that are in the library. I’ve gone through one about heart bypass surgery, one about blind children and how they develop, and a guide to the care and feeding of children from 1914. It details such important things as what kind of milk to give kids (not from Jersey cows; that’s too rich), what to do when they’ve having seizures (immobilize them and wrap them in mustard), and how to cure conjunctivitis (boric acid). We have yet to be shown around the hospital or introduced to people, which was on the schedule for the first morning.
The first day it only took about three hours for them to come find us. We ended up watching some surgeries. Although we were told that Dr Kalua was the only ophthalmologist in the country, it turns out there are three now. As it happens, all three are out of the country this week (India, Tanzania, and Argentina), but the simple surgeries are delegated to ophthalmic medical assistants or whatever they call themselves here. “Simple”, in this case, means anything where vision or the eye won’t be affected — so removing conjunctival tumours (which are on the surface), or removing eyeballs that are completely blind. The enucleation (eye removal) was like something out of a horror movie — he actually dropped the severed eyeball so it rolled down the patient’s forehead and almost dropped to the floor! After this, it was time for lunch. Two hours later, we went looking for anybody to tell us what to do, but there were no patients, so we just sat around until it was time to go.
The second day we were going even more stir-crazy — it took until almost 3pm for them to get us! (We start, officially, at 7am, so that’s 8h of being bored in the library.) We’re supposed to have an internet connection here, but all three ports in the library are broken. We wander down the hall to the lecture room, where the connection does actually work. When we’re called, we get to sit in on the assistant doing some partial eye exams. Most of it is pretty basic stuff, like allergic conjunctivitis, although we’ve seen a couple foreign bodies too. Apparently nobody has told him where we are in our education — he asks us if we’ve used a slit lamp before! (This is something we learned in our first term of school, before we even got into the preclinic.)
The third day, we were definitely running on Malawi time — they didn’t get us until about 3:30! We also learned that “I’m coming” means that they might eventually come, in an hour or two, and “I’ll be there in five minutes” means approximately three hours. We’re back to observing eye exams, and today we have the benefit of a couple screaming children. Kids seem terrified of us — it seems doctors are bad enough, but white doctors are just plain scary. To top it all off, we’re kept late because there are too many patients! It seems to me that, rather than keeping us qualified people around doing nothing, we could have helped to alleviate the mad rush of patients, right?
So today, we’re hoping Dr Kalua comes back and gives us something productive to do!

On a side note, I’ve got a cellphone here, so if you feel like talking or texting, the number’s on my Facebook page. Keep in mind it’s an international call (country code 265) and a 6-hour time difference from EST!