Three Weeks in Katete

We’ve now been in Katete for 3 weeks so thought it was time for an update!  The rains seem to have set in here, although there are usually a few nice days followed by  some pretty wet ones so not too bad. We are settling into a quite a nice rhythm of busy days at work, dinner in the mess and then some relaxation time.  We had ‘curry night’ on Monday and managed a chicken Rogan Josh (of sorts, not a patch on a Selly Oak curry though) and Nat one of the other doctors made a delicious butternut squash curry. After alternating meat and chicken stew it certainly makes a change.

Life in the hospital is getting busy.  We have just finished a 12-day stretch before a weekend, so feeling fairly exhausted. I started off working in paediatrics and having never done any paeds before this was quite daunting. It’s the busy time of year for paediatrics as rainy season equals malaria season (because mosquitoes breed in stagnant water collections), so the ward is fairly full, often with more than one child to a bed.  The ward (called Mbusa) has about 60 children on at the moment and is expected to get busier.  It is divided into an ITU (so called because there are 2 oxygen concentrators), a malnutrition area and then some general paediatrics bays.  Most children are admitted with malaria, pneumonia, gastroenteritis and dehydration or quite often a combination of the above. Although the nurses are very good, the children often present late and so sadly the mortality is fairly high. This has taken a bit of getting used to (and I suppose it’s not something you ever want to get completely used to) and what is often hard is the feeling that if we had the facilities a lot of these children could survive. They are dying from preventable, treatable conditions which is pretty tragic.  On the plus side, plenty of really sick ones where the outlook seems bleak  in the evening turn the corner really quickly and can be sitting up playing the next morning.  The weekend I just spent on call for paediatrics was definitely one of the toughest things I’ve had to do (neonatal resuscitation is not my area!) and I was relieved to return to the adult ward which I’ll now be on during the week to balance out numbers.

Our exciting project of the week is that we are in the process of having a garden made!!  Our house is all one room, so we thought it would be nice to have some outdoor space where we could sit in the sun in a bit of privacy.  Our gardener Nelson has so far fenced off a bit of grass or rather scrub with rather a nice straw and wood fence (photos to follow…).  I think he is rather bemused/perplexed by our wish for ‘grass to sit on’ and so we came back at lunchtime to find him digging up(!!) our nice bit of newly fenced off grass!  So we have compromised and he is only cultivating one third of it to plant crops (eggplants or maize I think).  I guess the idea of having a patch of land for recreation rather than sustenance is rather an extravagant one..

We are very excited about our trip to the great metropolis of Chipata tomorrow, for some much needed supermarket indulgence, as well as swimming and burgers at a hotel (luxury!)!

Becca xx

Arriving in Katete

We have now been at St Francis’ for just over a week.  We travelled here on Wednesday 2^nd January and were welcomed to Zambia by an almighty downpour of rain which followed us along the Great Eastern Road as we were driven the 100km from the border to the hospital.  On arrival we were impressed to find a nice little studio which is to be our home for the next six months (complete with double bed, fridge, cooker and hot water!!)   Now with the addition of our filter coffee machine and 2kg Malawi coffee, we are only one guardian subscription away (I don’t think they deliver here) from a very pleasant existence.  For food, our evening meals are provided by the Doctors’ Mess, where Patrick and his team cook up an excellent selection of Goat stew and rice, chicken stew and rice, Fluorescent-red sausages and spaghetti, and of course the quintessential Sunday chicken roast – sort of (Becca)

After a day to settle in, we started work on Friday, and had to fight it out between Medicine and Paediatrics.  Becca won (LOST!! – Becca) and has spent the week on the Paeds Ward, opting for the baptism-of-fire approach to African Medicine.  With Fi (a GP trainee who has been here for 6 months) as a tutor, she seems to have become quickly quite confident, and her language skills in local Chichewa have come on a lot more than mine (although I can now ask about coughs, diarrhoea, and tell people to sit up and lie down). 

The adult male medical ward has become my main place of work, and is fortunately not too alien an environment.  There are some similarities with the UK (you have to get along with the nurses, drug charts go missing, and most people go home eventually, although some die).  The differences are mainly the underlying conditions, with most being HIV positive, often newly diagnosed with advanced HIV, and most patients being the same age as me.  It has been a good challenge, diagnosing and treating without the benefit of many investigations, and reassuringly our management does seem to work in most cases (learning a bit of Tropical Medicine in Liverpool has certainly helped). 

After ward rounds we head to the outpatient department (OPD) which has taken a bit of getting used to, but is quite good fun.  Patients turn up in the morning and join the queue for clinic, turning up with anything and everything, in all conditions from being completely well to moribund.  There are usually 3-4 doctors sitting in one room with a patient each, and a couple of translators providing interpretation, as well as, I think, a good measure of their own advice.   The whole thing seems somewhere between General Practice, A&E and a medical clinic, which gives a good amount of variety.  The lack of confidentiality is quite something to get used to as everyone hears everyone else’s problems in details, and sometimes even gets involved themselves!

I think we will enjoy our next six months in Katete, as I think the clinical work will be good fun and interesting, and the doctors mess has a great social atmosphere.  I hope that as well as providing clinical care, although more challenging, we will have a positive impact on the educational and organisational side of things, although we are realistic about the likelihood of this happening.

Our House (the outside)

Our House (the inside)

Our Travels
(sorry if you’ve already read this in e-mail form!)

We arrived in Lilongwe on 11^th December, (followed by our luggage 24 hours later) for a three week holiday in Malawi and a trip to Zanzibar.  After two days in Lilongwe, we took a deep breath and headed to the bus station.  The journey was to Cape Maclear on Lake Malawi (Becca enjoyed having a small Malawian child on her lap for some of the journey, but fortunately she stayed on the bus).  We met Claire and Matt there and had a great few days in the beautiful surroundings relaxing by the lake, swimming, snorkelling and enjoying the local band (5 small Malawian boys who would perform an impromptu concert for a small fee - we're not sure if they take overseas bookings...)  Sadly this was not to last forever, and our next stop was the city of Blantyre in the South and its famous Queen Elizabeth Hospital for a bit of Liverpool School of Tropical Medicine tourism (we heard a lot about it on our course)...  

Training for the Malawi Olympic Gymnastics Team?

Sundowner G&Ts

Life on the Lake

We then flew from Lilongwe to Dar es Salaam and took the boat across to Zanzibar (something that I had vowed that I would never do again).  Fortunately this time the boat was fine, and we all arrived unscathed to the stunning Stone town and enjoyed Tanzanian beer as the sun was setting and delicious street food.  The next stop was Pongwe beach on the east coast for four days in tropical paradise, which involved more swimming, snorkelling, walking along the beach and inventing 'Coral Boule' which provided hours of entertainment throwing bits of washed up coral along the beach.  We were very sad to say goodbye to Claire and Matt who had to fly home, and consoled ourself with another beach trip, this time to Jambiani beach in the south where we spent Christmas (somehow we ended up having a candlelit dinner on the beach under the stars - mainly thanks to a powercut...).  It was strange having a hot Christmas day and we missed everyone at home.  

Sunset in Stone Town

Jambiani Beach

Christmas on Jambiani 

It was time to start the long journey overland back to Malawi following another (fortunately) uneventful boat trip back to the mainland.  Highlights included seeing zebras and giraffes as the bus sped through a national park, and various other bus journeys involving chickens, new born babies and patients from Karonga hospital. We eventually stopped for a couple of days in North Malawi and climbed a mountain up to Livingstonia, a Scottish missionary town that had more in common with a national trust estate than anything else we had seen in Africa.  Another two buses (involving multiple baboon sightings) took us to Nkhata bay where we spent New Year with two very nice French people, a lot of people on gap years and some very excitable Malawians (one who took a particular liking to Becca called "Guacamole toast" - we're not sure if that was his real name but his brother ensured us that it was).  We partied until the small hours and then had a brief snooze before catching the 6.30am bus back to Lilongwe.  After seven bus journeys in six days lasting a total of 33 hours, we are now getting ready to cross the border to Zambia and on to St Francis Hospital tomorrow.  

We will be sad to leave Malawi which we have really liked - the people have been so friendly and cheerful despite the obvious poverty, and the countryside and lake so beautiful.  However, we have heard good things about Zambia (we met a Dutch chap who had cycled 1800km across the north of Zambia in 2 months!!! as part of his overland trip south from Holland to South Africa, so far taking 13 months), and we are actually looking forward to starting work.