A Leap of Faith

I decided to end this blog as my fourth and final year of pharmacy school comes to a close. After my African adventures, I spent two months in Pittsburgh, flying under the radar with family and friends. I also completed my last pharmacy rotation at a nearby independent community pharmacy. The laid-back and friendly site was the perfect way to round out my pharmacy education.

It is hard to believe that my fourth year of pharmacy school has already come and gone. On one hand, it seems to have passed quickly; on the other, my first transplant rotation last May seems like it was ages ago. It’s even harder to believe that I am finally finished with my college education. Two years of undergraduate studies followed immediately by four years of pharmacy graduate work was enough for me to feel burnt out by the end. More than ever, I am ready for a change. I am eager to leave my days as a student behind, and move forward to take on the responsibilities of a pharmacist. 

So what does that look like exactly? Well, if you remember, I decided to pursue a pharmacy career with the military after my rotation with the Coast Guard last fall. That remains my current long-term goal. However, the application process is slow and competitive, so I made a decision to head west in the meantime. Originally, I booked a flight to visit my sister, Anna, and her husband, Alex, in Denver this spring. Eventually, this trip turned into my crazy idea to stay indefinitely. After all, I had already wrapped up everything at Pitt and had no desire to attend graduation.

I will admit that my decision is risky (i.e., relocating without a job or apartment), but I am excited to get out on my own and seek new adventures, finally free from my university ties. Before you start worrying, I do have a tentative plan for my fresh start in Denver. I will stay with Anna and Alex for a few weeks while I search for a studio apartment downtown. Hopefully, I can support myself through part-time hourly work, while I study for my pharmacy licensing exams. If all goes well, I will be licensed this summer, at which point I will search for employment opportunities to gain pharmacy experience—ideally in an independent community pharmacy. I still intend to submit my application to become a military pharmacy officer, but I also realize the beauty in keeping my options open. If things are going well in Denver, there is no need to rush into joining the military, especially when I can apply the following year.

So that’s my speculative plan for the next few months or so, but I realize that life changes on a dime. I intend to take one step at a time, and remain open to accepting new opportunities if and when they come knocking. It may sounds cheesy, but today feels like the first day of the rest of my life. I have a one-way ticket to Denver, and my most important possessions shoved into two suitcases. I am wildly optimistic about what lies ahead—in Denver and wherever life takes me after that—never loosing sight of where I’ve come from.

Stay tuned for a new blog about my next chapter in Denver!

A Reflection on the Warm Heart of Africa

In 2014, Malawi was named the poorest country in the world. So what impact is made, then, on someone that travels from one of the wealthiest nations in the world to one of the poorest? Everyone is different, I suppose, but here are some of my biggest learning points:

Be grateful always. I heard an NPR podcast recently about a monk's perception of gratefulness. He explained that gratefulness occurs when something valuable is given to us--not bought, earned, traded in, nor worked for. In general, I found that Malawians are excellent at practicing gratefulness, which in turn brings them happiness. Furthermore, most of them lead simple lives relative to those in first-world countries, which I think adds to their happiness. Having less can often to lead to less stress, anxiety, complications, and interruptions. Despite the overwhelming poverty, the positive and upbeat attitude portrayed by Malawians truly earns them the title of the "Warm Heart of Africa."

This journey has also taught me a thing or two about myself. This was not my first experience in a third-world country, but it was the greatest test of my comfort zone. I don't need (or want) luxuries like television and dishwashers, but basic necessities like running water and electricity were a struggle for me to go without. And the safety concerns tied to leaving the house alone to walk or run was even more difficult for me to accept. I am surprised that I did not adjust more readily, but I think that it's important to know and respect the boundaries of your own comfort zone.

For that reason, my time in Malawi has given me insight into my professional goals. Since pharmacy school began, I always envisioned a future of working in third-world countries with a humanitarian group like MSF (Doctors Without Borders). However, I am now uncertain whether or not this is the best path for me. I remain interested in global health and underserved populations, but perhaps my approach to do this will be slightly less extreme. For example, down the road, I would still consider volunteering with MSF in areas in need, but only on a short-term basis. Additionally, my time at the hospital, though interesting, has confirmed my decision against pursuing a career in clinical pharmacy. I would be happier working in a community or ambulatory care setting after graduation.

In exchange for these realizations, I hope that I was able to make an impact in Malawi. The project completed by Ryan and I at DLH was a beneficial way to give back to the hospital. Aside from that, I am optimistic about the knowledge that we spread through the various areas of the hospital and through the people that we met. In this way, it seems that Malawi and I have left our marks on each other. Malawi is a country full of potential and hope, and I believe that it will continue to develop and prosper in the years to come.

So what's next on my agenda? My long string of travels has come to an end, which leaves me (mostly) in Pittsburgh until graduation in April. I have two full weeks off to job hunt and what not before my final rotation begins--stay tuned!

So Long, Malawi, Until We Meet Again...

Instead of going to the hospital on Monday morning, Ryan and I stayed at Gerry’s house to analyze the data that we collected for our project. We began to transform our work into a presentation that we would give at the hospital the following day.

For lunch, Nancy cooked a delicious barley soup with potato, onion, and carrot. She also made wonderful stuffed soufflé tomatoes.

Nancy’s Stuffed Soufflé Tomatoes

Boil water in skillet; add milk, Gouda cheese, 2 egg yolks, and a pinch of salt

Beat egg whites separately

Combine both mixtures when they are stiff

Cut off top of tomato to make a “lid,” and remove insides

Stuff mixture inside tomato, add extra cheese on top, and cover with lid

Bake stuffed tomatoes in glass pan for 15-20 minutes

Gerry drove us to DLH that afternoon, where we met with a small group of nurses to gain insight for our project’s final outcome.

This week’s HASH was located just outside Lilongwe, so we unfortunately did not make it in time to run with the group. We did, however, have dinner with Sarah, Dr. Makin, and the Podgores—the "last supper," if you will. James made two curries: goat and eggplant. Tea and a platter of fresh mango, pineapple, and banana were prepared for dessert. I will miss the fresh produce of Malawi—and Nali hot sauce!

  

Sarah and I went for our last run together on Tuesday morning. I already miss greeting the locals with the standard exchange:

Muli bwanji? (How are you?)

Ndili bwino. (I am fine.)

Zikomo. (Thank you, good day.)

Afterwards, Ryan and I presented our project findings at the morning Handover meeting. We prepared a brief slide set in order to illustrate our recommendations for the hospital based on the time and motion data that we had collected the past three weeks. The presentation was successful, and our recommendations were well received. It helped to have some friendly faces in the audience, including the Podgores. Gerry and the residents also attended.

Before leaving DLH, we said our final goodbyes to Sarah and the Podgores. They are a truly special group of people, and I feel blessed to have met them in Malawi. My experience would surely not have been the same without them. I am hopeful that our paths will cross again someday. Ryan and I also said goodbye to Maria at the pharmacy on our way out.

Gerry dropped off the residents at KCH on our way back to Area 3. Ryan and I walked into town for the last time, making a few stops at the grocery stores, pharmacy, and souvenir shops. We also had our last smoothies at Kiboko’s restaurant.

Back at the house, we heated up leftover lasagna for lunch, and I chatted with Nancy about some of her recipes.

The afternoon was spent packing and finishing up assignments for the rotation. Gerry’s colleague, Abi, joined us for dinner. Nancy prepared tasty squash soup, a spinach and feta phyllo pie, and chicken for the meat eaters. Abi also brought a spicy Indian dish called "dahl." Lemon cake for dessert!

Wednesday was my last day in Malawi. I said goodbye to the residents in the morning before they left for KCH. After breakfast, I zipped up my bags and waited anxiously to go to the airport. Before leaving “Camp Douglas,” I said goodbye to Jeremy, Chipi, and to sweet Nancy—one of my favorite Malawians. Gerry was also on our flight to Kenya for a conference meeting, so we all drove to the airport together. There we used the remainder of our kwacha to watch planes fly in and take off from the upper deck area.

Our flight left at 2:30 pm, made a brief stop in Lusaka, Zambia (where we did not change planes), and departed again for Nairobi, Kenya. It was hard to believe that Ryan and I had celebrated the New Year there almost a month ago. We parted ways with Gerry, and waited for our overnight flight to Amsterdam. Back to the wintery northern hemisphere!

After a 5-hour layover, we flew to Detroit—stateside at last! We landed in Pittsburgh around 5 pm, where my dad was waiting for me at the airport. There I said goodbye to Ryan, my dear travel buddy who stuck it out with me when things got tough. I am grateful to have had him along with me for this extraordinary journey.

On the way home, I looked out the car window at the bare and dead earth. Jumping straight from summer to winter would be tough, but I was glad to be home for a few months. After all, I’ve been on the move since my Carolina rotation in October. Four months of traveling is exhausting, and I am content that my final rotation will be in Pittsburgh... graduation is just around the corner!

Balloon Rounds

There were plans in the pipeline to visit a different area of Lake Malawi this weekend. However, due to miscommunication and transportation issues, I returned to DLH to spend my final weekend in Malawi with Sarah and the Podgores.

On Saturday morning, they picked me up in Area 3 after dropping off Kate at the airport. We went to the Old Town Mall, which is full of galleria-type shops, one of which is called African Habitat. We also stopped at the grocery story, Chipiku, and an Indian restaurant for lunch. On the way back, we paid a short visit to the chaotic Main Market to buy fruit.

A short note on the driving/road culture in Malawi; apart from a few main roads that are paved, most are red dirt roads, dangerously uneven with rocks and ditches. There are very few streetlights, and even fewer that actually work. Roundabouts and speed bumps (or “sleeping policeman,” as the Podgores call them) are common. Actual policeman stand guard at checkpoints and periodically check licenses and registrations. Driving is on the left, passing is frequent, and dodging packed minibuses and pedestrians on foot or bicycle is a must.

After the busy morning, we took a short siesta at the Podgore’s house. Later on, Sarah and I completed a yoga session before cooking dinner. We decided to make vegetable lasagna—roasted vegetables layered with a mix of cheeses and fresh sauce made from the famous Malawian tomatoes. Armed only with past experience and intuition, we made a few improvisations and substitutions. Nevertheless, it turned out fantastic—a huge hit with the Podgores!

That night, we heard from Kate that her flight from South Africa to Washington D.C. was indeed canceled after the snowstorm hit. She would be forced to spend the night in Johannesburg and book another flight back home. What awful timing.

The night ended with an interesting movie about the first cardiac surgery performed at Johns Hopkins University.

Sarah and I started Sunday with a morning run. The sunrise was—as always—incredible.

After breakfast, we went to mass. There is a Presbyterian church at DLH that offers services in English and Chichewa. The English mass was quite enjoyable, consisting largely of songs of praise by the choir.

Sarah and I stayed for the Chichewa mass, which was slightly different. The church was packed, and there was even more song and dance—which, according to the pastor, is innate to their African blood. Adult and children choirs performed, but the entire congregation actively participated.

After lunch, Sarah and I played a board game and made banana bread out of the over-ripe bananas purchased at the market the day before.

That afternoon, the five of us walked down to the hospital. Dr. Podgore was asked to consult on a very sick newborn with tetanus, weighing less than three pounds. It was very sad to see, as the baby will likely not make it.

On a happier note, we also went to the pediatric ward for “balloon rounds.” Periodically, the Podgores visit the children on the weekend, and bring toys and balloons. It was extremely heartening to see the joy spread by our visit. Children, mothers, and grandmothers were all smiles.

Later that afternoon, we welcomed a brief thunderstorm and a brilliant rainbow.

The weekend came to a close with a communal pancake dinner at the Chinchins’ house—founders of the ABC. There I met and mingled with several missionaries and volunteers working in Malawi. I found this tight-knit and altruistic community to be quite inspirational.

Afterwards, the Podgores dropped me off in Area 3, where I caught up with Ryan and the residents, and crawled into bed. Three days left in Malawi.

Chikondi Malawi

On Monday, Ryan and I began our last full week at DLH. We spent the morning in the pharmacy, taking an active role in dispensing. The pharmacy attendant, Myah, made us a Chichewa cheat sheet containing the most pertinent words for the pharmacy. It was both fun and challenging to dispense medications in this way. It was also rewarding to know that we were contributing (at least in some small way) to the pharmacy and hospital.

In the afternoon, we made progress on our project plans before meeting the Texans for the HASH run. The Norwegian family hosted this week, so we drove to their house and waited for the activities to begin. There was a good turnout, likely because most people have now returned to Malawi from holiday. I saw a few old faces from last week, including the nurse Emily, but there were also some fresh faces. Similar to last week, I enjoyed making new connections and learning of their stories. I joined the “long run” again in order to take advantage of the infrequent exercise opportunity. The temperature had cooled down noticeably, dropping to the low 70s and even 60s at night. Relative to the previous heat, it felt quite cold, but also made for perfect running weather.

The various walking and running groups ended back at the Norwegian’s house, where we shared snacks, drinks, and the usual traditions. The night concluded with dinner at the Podgore’s house.

We managed to get through Tuesday with scarce electricity and water. In the morning, I collected project data from a nurse in the male ward. The afternoon was spent helping inventory and pre-pack in the pharmacy. Dinner at the Texans’ house was extra special for the honorary guests—Korean mission workers. James prepared a colorful vegetable salad, coleslaw, fried eggplant, rice with chakalaka (a spicy vegetable dish from South Africa), and penne with chicken. For dessert, we were spoiled with chocolate cake and cookies, and the usual Rooibos tea. I greatly admire and appreciate the sense of community and generosity fostered by the Podgores.

I woke up on Wednesday in realization that I would be leaving Malawi in exactly one week. I joined Sarah for a 5:30 am run before going to work.

Ryan and I attended the morning Handover meeting, and from there, we followed two physicians. I collected project data from Dr. Gary in the pediatric ward. Not surprisingly, most children had malaria. Their piercing and fearful screams always grew louder when a nurse or physician drew near.

The weather was perfect—sunny and warm, but not too hot. More guests joined us at the Podgore's house for dinner that night. This time, we welcomed our German friends from HASH, Florian and Franziska. After the meal, we watched a documentary about Burkitt’s lymphoma in Malawi.

Both Sarah and Kate showed up for a morning run on Thursday. They have been working at KCH this week (like Amy and Ashlyn), where they noticed several differences from DLH. For example, KCH is the main hospital in Lilongwe, which has specific clinics, including HIV. Because it’s free and centrally located, most patients are in worse shape than those at DLH in terms of health, nourishment, cleanliness, etc. It would have been interesting to personally witness this distinction.

Handover was composed of the usual update given by the overnight healthcare workers that always seem to present their reports in a whisper. Afterwards, Ryan and I joined Dr. Podgore, Sarah, and Kate on the pediatric ward rounds. I made it a point to choose an interesting case to present back in Pittsburgh. We returned to the pharmacy in the afternoon, before walking up the hill to have dinner with the Texans. Always an enjoyable evening with our second family.

Friday was wonderful. After a morning run, Ryan and I were invited to spend the day with the Texans.  We had cereal and bananas for breakfast (my favorite!) before departing for the KCH campus. Kate and Sarah dropped off freshly baked cookies at the Baylor HIV clinic, where they had spent time earlier in the week. Next door, the University of North Carolina clinic was hosting a blood drive. There was a current shortage of blood, so we were eager to help. Unfortunately, however, my iron levels were too low to donate.

That afternoon, we visited Ione's NGO that is located in a very rural and poor area of Lilongwe. Within this small community, Ione and her sponsors created a feeding center that provides breakfast and lunch to the orphans in school. The Chikondi Malawi program feeds over 700. Chickondi means "love" in Chichewa.

We began our visit in the main schoolhouse, where the primary school children were practicing English and math. The nursery-aged children had already come and gone that morning. I was stunned by the amount of children clustered in the tiny room. I was equally shocked by their infectious happiness. They had clean clothes, food, and a roof over their heads—everything that they needed to be content.

After the lesson, the children lined up for lunch. The feeding center had prepared large vats of rice or nsima, beans, and vegetables. Again I was fascinated by how well behaved the children were. They weren’t fighting or crying, but rather happy to be alive and well. And to my delight, they loved having their picture taken.

 

Many children in secondary school come from remote areas (some as far as four hours on bicycle) to receive education. These students are housed in a dormitory throughout the school year. We visited the girl’s dormitory, where the young women put on a brief performance of song and dance. The choir passionately rang out enthusiastic hymns. It was genuinely beautiful and harmonious—a truly moving experience. These women lead extraordinary lives, studying in the early and late hours of the day when not working in the fields or in the house.

Video 1. Secondary school-girl performance

Later on, we walked through the villages, visiting several families and groups of people. The stares that we received that day were a mix of confusion, curiosity, and amusement. Sarah, Kate, Ryan, and I each offered a quilt to an elderly member of the community. We were also asked to pray for them. Most asked for good health or resolution of pain, or often for rain. To my surprise, one older man pleaded to stop drinking alcohol.

We also passed through the crops belonging to the feeding center. Despite the drought, the fields of corn (or maize) grew tall. Also in the area were fields of beans and a vegetable garden, as well as tobacco crops that do not belong to the feeding center. It was a mighty hot day in Lilongwe.

The feeding center left me feeling humbled by the global happiness of the community. At the hospital, I am accustomed to seeing sick patients that do not wish to be there. In contrast, this experience led me to witness normal Malawians going about their daily lives. Malawi is one of the poorest nations in the world, yet its population is generally content and grateful for what they do have. This finding leads me to argue the point that people are happier with less. Simplicity too often goes underrated. I will never forget the children’s smiling faces, beaming energy, and the countless waves and kisses directed at us. Should you have any interest in learning more about Ione’s program, please visit the following website: www.chikondimalawi.org.

On the way back to the Podgore’s house, we stopped at the specialty grocery store, Kapani. We then shared lunch at their house before departing again. Our first stop was at the African Bible College (ABC)—a Christian community, school, and health clinic founded by missionaries. This network is also established in Liberia and Uganda.

Afterwards, we drove to Old Town to peruse the craft stall vendors and to share a drink at Kiboko’s restaurant nearby. It was our last night with Kate, as she was to return to Texas the following morning. A snowstorm was forecasted to hit the North East, so we were all hoping that her flight to Washington D.C. would not be canceled.

After watching the sunset-colored clouds from the restaurant balcony, the Podgores dropped Ryan and I off at Gerry’s house in Area 3. There we ate dinner with the residents and the new addition to the house—Gerry’s colleague, Jeremy. Gerry had just recently returned from a brief business trip to Korea. I fell asleep that night in anticipation of my last weekend in Malawi.