efficiency?

For a patient to be seen on a Tuesday (and I assume other days though I don’t know) they come in through the outpatients receiving room…where they get a stamp in their health passports (medical records that they keep). They are to get weighed and temperature taken…then they pay 80MK (roughly $.40) for a consult. On a regular day this will get them seen by a clinical officer (Malawian equivalent to a very junior doctor?). on clinic days this gets them to the doctor…so they come to the hallway outside the doctors rooms…and they sit. There is no order for anything. An assistant comes by and takes the passports into the first room where I have a feeling they get shuffled (I really think it should be first come first serve but the books are constantly being mixed up)…they are called in to get their blood pressures done and blood sugars if needed and then they go back out to wait in the hallway while the books go into the next room for the doctor…of course the time taken depends on the number of doctors who are there that day and whether there are complications in the patients…and of course if you are a headman of a village or area or a staff member or related to a staff member (as it feels like everyone is) you don’t have to wait—often getting bumped to the front of the stacks…even though others have been waiting for ages…and then I have to remember to take a deep breath and know that everyone will get seen…

clinic drs

I’ve really enjoyed helping with the epilepsy clinic…not being much of a medical person it is something that I feel that I can do…we only have three drugs that we can use to treat epilepsy and I feel like I’ve gotten pretty good at knowing what the doctor is going to do from the questions asked (namely how many seizures have you had since you’re last visit—continue if none and usually add if they’ve had some). And of course there have been different doctors who help with the clinic—some who have been visiting for short times and others who are filling in or helping out on particularly busy Tuesdays…easily on any given day there are 50 patients for clinic (this includes epilepsy, diabetes, and high blood pressure along with other random ailments) and it has been interesting to see the differences…some ask about whether the people are going or have gone to school, or whether they are on contraception, or if they are drinking or smoking (that is a pretty common question), if they know their HIV status…and the answers we get are sometimes sounding very unbelievable …or nonsensible (when did you run out of medication? I take it always—helpful if you have it but if you’re out…)…but you have to take the answers you get because what else do you have?

unrest

Malawi needs our prayers. There has been lots of unrest and it has started getting into the school children as well. I found out at bible study last night that the last couple of weeks in the schools around nkhoma incidents have been happening. At the government school last week a guy from one of the villages went into the hostels (where most of the students stay) with a ponga knife (machete) and was harassing students. Last weekend there was a soccer game that got out of hand and in the fight afterward a primary school student was killed. And at the private boys school William Murray all of the Form 3 and 4 students have been expelled because there was fighting over another soccer game (I think). This means they will not be able to sit exams and will have to reapply to the school. I don’t know what the underlying causes are or if these are the true stories (well whole stories).
Along with the petrol, diesel, and gas (propane) crisis…please keep Malawi in your prayers.

turkey

Just got the most expensive turkey I’m sure I will ever eat…but then thanksgiving only comes once a year…and if I screw it up it will be very very sad…which it would be anyway but especially since this one is dear…
HAVE A HAPPY THANKSGIVING!!!

construction

So I’ve been living (once again) on a construction site…the house that I’m sitting in (with a great view and great neighbors) is undergoing renovations…these were (of course) started when the family was here but as everything takes much much much longer than anticipated it is still going on. Well they come back on Sunday…(sadly I’ll be evicted)…and I’d have to say they are going to be surprised (pleasantly I hope) by all the work that has gone on. It does still feel that it has been all last minute—so much going on this week but it is getting somewhere! The bathroom floor was retiled—and of course they pulled up the old linoleum tiles at least a week before actually doing the new ones so I walked on the sticky stuff for the duration…the sink was leaking and they didn’t want to put the tiles in until that was fixed. Ok. But everytime the plumber came back the drip was different—and not always better…but that was done and then the tiles started…that took about three days to finish what with the power cuts so the grinder wouldn’t work to cut the tiles around all the door frames and toilets…
The front porch is getting a roof put on it…so really I haven’t been able to use the front porch much because it is a huge mess of dust and grit and I’ll admit I’m a little worried something might fall on my head as it isn’t finished yet…then it got the tresses (supports?) up and stayed like that for ages (maybe only a week and a half)…then they came and took the tiles off part of the existing roof so they could integrated it…and left it like that for 3 days…but today I came home and over half of it has been tiled…and the rest will be done tomorrow (so I’ve been told).
And the back kitchen door had a concrete patio area put in…not really a patio but a stepping place that wasn’t just mud…so they dug up the area…put in gravel and then paved half of it—and left it for 2 weeks…that was just finished yesterday with the paving…and today they put the smooth finish on it…I hope it is tilted slightly in the right direction...otherwise the water will just flow right into the kitchen. The roof for that area should also be coming tomorrow…

supplies

I’ve never had so much trouble helping out…for the last month or so while helping to make patient files at the hospital it has been one obstacle after another…and I told Rebecca I would take care of it—well, try at least which I have done. So I noticed that we were getting low on folders…and they have to be printed in Lilongwe…of course I don’t know what is involved in the actual ordering…it has to go through the accounts office and someone else has to check it and there has to be a price estimate (can’t imagine it is that different from the last time we ordered) and then you have to wait on the printer…before we actually ran out of folders though the copy machine ran out of toner (no ink=no copies) so we had none of the requisite papers to go into the folders…this includes a chart to note medication (needed and given) and observation chart (with vital signs) and the admission history sheet…we made due with what we did have and just added blank papers for the rest…but that ordering was the same rigamarole…plus the hesitancy to buy any because it is quite expensive here and there was someone coming from abroad soon who was bringing some…but he didn’t…so then we got toner…and we were out of the clasps that hold the folders together…and then out of staples that hold the half sheet pockets we put in the back for all the small papers (lab reports, xray requests, etc)…but now we are all back on track again…
Now I’m on a mission for scratch paper that I cut in half to use for those pockets…I use quite a bit from the school—copies gone wrong and such…much better than using plain white paper that would be so useful as copy paper…

rain?!

It rained last Sunday…and I mean poured! And it wounded like there was a raging river off the roof onto the porch just outside my window. I love the sound of rain…this however came with all sorts of wind that then made all the windows and doors slam around and make lots of noise because of course they were all open to get any sort of breeze…but this meant in the middle of the night I was wandering around trying to find all of the open and banging offenders…found most of them and slept oh so well.
And 2 days later the bugs arrived…after the first 3 rains the termites (or ants with wings) all start coming out of the ground…ute and I were sitting on the rock in front of my house watching the sunset colors and we looked around to this paved area and there were some beautiful birds hopping around eating something…the birds were this dark purple and when the light hit them they were iridescent..it was beautiful—one of them did a little tour right in front of us almost like he was just showing off. We couldn’t tell what they were feasting on but a few minutes later we saw these columns of bugs coming straight out of the ground and flying up…the birds were having a field day and the number of bugs just had us in awe…found out later they were termites—loses some of its appeal but it was cool. And now there are these beetles that are swarming any light that is left on…hard to walk through to get to doors but we’re managing…