Our first day of rotation was interesting. After breakfast,
Chipi drove us about 40 minutes away to the outskirts of Lilongwe, where we arrived at Daeyang Luke Hospital (DLH). Founded by Korean missionaries in 2008,
the hospital is a small yet modern facility where patients pay a small price for treatment. It shares a campus with the
Daeyang nursing and IT colleges. A medical school is also in the pipeline.
Ryan and I were shown our rooms in the student dormitories,
later to find out that the running water frequently comes and goes. We were
given buckets to collect water and bathe with. Still, the views of the countryside were unreal.
We toured the hospital and met several employees.
Most hospital workers dress professionally, in nursing uniforms, or in scrubs.
Business is typically done in Chichewa, but the healthcare team adjusts when
conversing with non-natives. The hospital is divided into wards, with patients
and visitors spilling into the open-air corridors. Many sit in the grassy areas
under trees. Body odors and fly infestations travel the halls. Yet, there is
something incredibly beautiful and graceful about how Malawians interact with
one another and go about their daily chores. Ryan and I spent the remainder of
the morning in the pharmacy, mainly observing and asking questions of the pharmacist, Maria.
Lunch is served in the college cafeteria at noon for less than $1/day, though free for students. I realized early that vegetarian options
would be hard to come by here, as I sat down with my plate of rice
and cooked eggs. I already missed Nancy’s cooking! I returned to the pharmacy
that afternoon to pre-pack medication packets that would be later dispensed to
patients. Ryan and I went again to the cafeteria for dinner, where we met two friendly nursing students.
Content after completing a full day of rotation, I will
admit that I had mixed feelings about the experience so far. I was grateful for
the opportunity, but something felt off, whether it was the heat, the culture
shock, or the structure of the rotation. It was as if I was constantly taking one
step forward, and two steps back. Nevertheless, I told myself to be patient and
keep my chin up, and see if things might change in the next few days.
Day two began with the daily Handover meeting at 7:30
am, where the overnight team reviews patient cases from the night before. In
addition, a U.S. OBGYN from Florida gave a presentation on recommended
techniques when performing cesarean section procedures. After the meeting, Ryan
and I met another U.S. physician and his two medical students from Texas.
The rest of the day, I shadowed the nurses on the female
nursing ward. I learned their place in the medication use process, observed
medication administration, and attended physician rounds on their ward. I
also observed a bedsore wound dressing of a young woman with metastatic cancer.
It was heart wrenching to witness her suffering. A healthy dose of perspective
was given to me as I realized how pathetic my challenges with adjusting to the new
experience seemed in comparison to her pain. She passed away two days later.
After some much-needed downtime, Ryan and I went for a walk.
We ate dinner in the cafeteria, still trying to get a handle on how things
work. Then a call from Gerry and some assignment work rounded out the night.
Still no rain.
My attitude started improving by Wednesday. After the Handover meeting, I shadowed the physician, Dr. Matiya. In the morning, we rounded on his patients in the internal and general medicine wards. In contrast to the interdisciplinary rounds conducted at many U.S. hospitals, the physician examines and treats his patients single-handedly. Also different is that he may see 40+ patients per day. It was interesting to compare notes on how we would attack each patient case. Unfortunately, several drug regimens that I suggested were not available in the country. Many patients—especially this time of year—have malaria. Others have HIV, tuberculosis, diarrheal diseases, and infections caused by various bacteria, viruses, and parasites. I expected most Malawians to be skinny, but quite a few—women, especially—are overweight.
Unable to take many photos without including people, I will do my best to describe the hospital. On the surface, it looks relatively modern; brick walls, cement floors, electricity, a number of specialized wards. After a second look, however, the scarcity of resources is obvious. To name a few, drugs, supplies, equipment, space, clean water, and trained staff are limiting factors. Dr. Matiya rationalized that even if the hospital were full of highly skilled Western doctors, the effect would still be blunted due to the lack of resources.
Both tired after the busy morning, we broke for lunch. I joined Ryan and our new Texan friends in the cafeteria, who kindly invited us to dinner at their house that night.
The rest of my afternoon was spent in the outpatient clinic with Dr. Matiya, assessing and treating patients with chronic conditions (i.e., high blood pressure and heart diseases). Tucked away in a small hot office, the patients lined up outside, filing in one after the other. During one visit, Dr. Matiya used an old ECG machine to record the patient’s heart rhythm. It was the first manual ECG machine that I had ever seen, and was donated from the U.S. a few years ago. Despite its age, Dr. Matiya swears by it. It made me feel guilty about how much waste I have witnessed in hospitals back home. It is also frustrating to see the full day of work that Dr. Matiya puts in six days a week, yet he is compensated so little. He explained how his local training is not recognized outside of Malawi, which would prevent him from leaving the country to work abroad (and earn more money). His plan is to try to complete his masters training abroad to change this feat. I hope that he does. 
By 4:30 pm, the last patient had gone, which left me feeling mentally and emotionally exhausted. Still, I was glad to join “the Texans” for dinner that night. Kate and Sarah are third- and fourth-year medical students, respectively. Dr. John Podgore supervises them during their rotation in Malawi. John and his wife, Ione, own a beautiful house in the gated community next to the hospital, and spend three months there every year. We shared a beer while getting to know each other better, each to his/her own interesting story. Sarah is originally from State College, while Kate has been to Africa several times already and shares my favorite city of Granada. John was previously an Army physician, and has lived around the world, including Egypt for eight years. The U.S. OBGYN, Sue Makin, also joined us. We shared a full-course Mexican-style meal, prepared by the Podgore's excellent cook named James. On full bellies, we watched a parasitology video before calling it a night. As we left, our new friends generously invited us to join them on their trip to Lake Malawi this weekend.
As Ryan and I walked back to our relatively dingy digs, I felt as if this was a turning point in my Malawian experience. In retrospect, I have made the following realizations regarding my struggles so far:
1. Going into this journey, I knew that I would be living in a third-world country that is deprived of many luxuries that I take for granted. Thus, it’s not that my expectations were too high, but rather it was more difficult than I anticipated adapting and adjusting to this new way of life. After all of my travels to date, I was surprised to be affected so by culture shock. It is embarrassing to admit in such a poor country that it is hard for me to bathe using buckets of water, to sleep under a dirty mosquito net, and to not be able to run as much as I would like. But it’s the truth.
2. On top of that, it is routine for me when traveling to a new place to actively research and make a list of everything that I want to see and do. Even during my IHS and USCG rotations, I explored the Carolinas and New England on the weekends. But Ryan helped me to understand that this is not that type of trip. We are not tourists, and do not have the means to explore the African country in the way that I had hoped. Ryan and I joked that the long days and simple way of living earns the trip’s theme to be “it’s something to do.” Malawians don’t need much to be happy. They don’t need running water or sightseeing trips around the country. We are here to learn about healthcare in a remote underserved area, and hopefully, to make a difference.
I find myself gradually adapting outside my comfort zone, and feel more at ease about the next three weeks. Furthermore, I am comforted by our newfound friendship with the Texans. Ryan and I spent our first week more or less on our own to figure out how things work and why things are the way that they are. Despite my strong sense of independence, I was yearning for more companionship. The Texans graciously took us in and made us feel less like outsiders. We even have plans for the weekend!
Thursday finally brought rain. It lasted no more than 30 minutes, and cleared up almost instantly, but everyone was relieved that the drought was over. If Chipi’s prediction is correct, two weeks of rain lie in store.
Sarah joined me for a short run around the hospital at 5:30 am. Although cloudy, it was a beautiful sunrise and cool morning. Not leaving the campus due to safety reasons, it still felt good to stretch my legs.
After Handover, Ryan and I went to the college library to finish an assigned presentation that we created about our initial observations of the hospital.
The Texans joined us for lunch, where I finally tried the local food, nsima (the "n" is silent). It's similar to rice, which is usually served with vegetables and/or meat, and is eaten with your hands. I found it quite bland, but it was a nice change from the daily rice.
Afterwards, Ryan and I left DLH to return to Area 3 for the remainder of the weekend. Chipi picked us up on his way back from the airport with two Pitt medical residents, Ashlyn and Amy, who would be staying with us at Gerry’s house. Gerry was finally set to fly in the following day.
20 days left in Malawi.
