1st week in Mzuzu blog that I forgot!!
on Rachael's VSO experience (Malawi), 26/Feb/2011 08:55, 34 days ago
So this is the official blog that I wrote to update last week and then forgot to bring my USB drive with me so here it is1st week in MzuzuI am keeping a very detailed blog on my laptop so am just going to give you 'highlights' as most of it is notes for me on areas I want to improve or things I want to think aboutSo on Sunday (13th Feb) We were all packed and ready to go at around 8am, as we were told 8-11 so I wasn't expecting anyone until at least 11 but thought I ought to be good and get ready. So at 9am one of the VSO organisers approaches me and says I'm really sorry but the hospital don't have any petrol so they won't be able to come and get you! She then said she'd try to phone the hospital director on monday to establish what their plans are and what they'd like to do. In light of this she decided to drive Czar and I to the VSO guest house to stay. We get there and decide we ought to go shopping as we had only brought snacks for the 4-5hr journey up to Mzuzu. So we trek off to the supermarket and then I decide to do some washing as I haven't managed to do any in the 1st week. Once I've done my washing and hung it out me, Czar, Tom and Kelly (who are staying in the guest house for 2 weeks until their house is ready) all settle down to watch a film. After about half an hour the wife (Amii) of the guy (Johann) who looks after the guest house offers to show us how to make Nsima.After about an hour maybe less, around 14.30 Mphatso phones and says the driver is at Riverside hotel and she has directed him to where we are and we are going to Mzuzu now, she also says if the driver brings a big enough van to take the furniture with us!! so Czar and I quickly repack everything shoving all our wet clothes into a bag and wait for the driver he arrives around 1500 with a huge truck but doesn't know anything about furniture. So I call Mphatso who says she'll speak to Johann as he knows what we need to take. Typically for Malawi Johann has popped to the shop as sunday is his day off. His wife says that she'll flash him (this is Malawi speak for calling someone and hanging up before they answer so as not to use your credit, called flashing as your number flashes up on their screen!) In the meantime the driver is moaning that he was waiting at riverside from 10 and no one had left contact numbers and blah blah blah... I then get a phone call from Jacob Nkandawire the hospital admisitrator who says he has spoken to Johann he knows where the furniture is and is about 5 mins away, half an hour later he turns up.Johann, the guard and our driver Colin then proceed to load the van with 2 double beds, 2 matresses, 1 coffee table, a diner table and 4 chairs and a wardrobe. The VSO guys have explained that the hospitals intention was for me to stay in on-site accommodation and they would find Czar a seperate house as they don't like volunteers of opposite sexes to share. Unfortunately the only house they could find was huge and therefore would like us to share the house but it was a long way from the hospital. Mphatso explained that there are two beds in the flat and considering how late it was getting it would be better to sleep in the flat and then go and see the house on monday. So we turn up at the flat at 23.00 and its the first floor and the hall light doesn't work so we unload our bags and stumble up the stairs. Czar has been in touch with another Philippino volunteer who is also living on site and she has re heated some food for us although it really didn't look very appetising and I was incredibly tired by this point. To be polite I ate a small amount then eventually we went to the flat. The sheets on the bed were filthy as was the whole flat... the hospital said they'd cleaned it after Becky moved out but if they did you cant tell, the bathroom is really gross but the tap wont stop running I've had a little look but it's a strange mixer tap and I can't figure it out so the whole room is really damp and the wood is all rotting away. The administrator provided us with the keys to the flat and said they'd show us around the house tomorrow. So anyway I crawl into my sleeping bag and fall asleep under a mosquito net with more holes in it than net!!Monday 14th FebruarySo Czar and I decide that we ought to go to see the hospital director and at least let her know that we have arrived but need some time to sort some things out. She seemed lovely and told Czar and I that they will try and organise an office for us both and give both of us dongles and laptops to do work on. She said to take Monday to sort things out and let her know if we have any problems ect. Then Jacob drives us to the house... the house is amazing, I didn't take any photos as I don't want to remember how beautiful it was. It was up near the directors house overlooking the whole of Mzuzu. It had a huge garden and about 7 very large rooms and a guest area, which had it's own bathroom, toilet, living room ect. It was lovely but my sensible head kicked in and we would have to pay a guard and a cleaner ect. (although the hospital said they'd cover them) we would also have to pay a lot of money to get a taxi into town every time and they would use the hospital drivers to collect us every morning which wouldn't be ideal if we want to be at work early!! So we had a long discussion and apparently one of the flats in the complex is only occupied for another 3 weeks so they have said that we can share the one bedroom flat for now and then when the other flat comes available one of us can move out into it. So for now czar and I are sharing. Not ideal as he is so noisy! He hawks all the time ( I think that's what its called when you make that gross noise to get the snot into your mouth!) and he wakes up about 5am and is so noisy... its hard living together and his English isn't brilliant which make it more difficult.So Anyway, they then drop us in town so we can get some of our money changed and buy some cleaning equipment and some food and then pretty much spend the rest of the day cleaning. It is really frustrating in the flat as not only does the hall light not work but our inside hall light doesn't work, the bathroom light doesn't work and to make matters worse my bedroom light doesn't work. I've spoken to the guard about it who said he'd ordered new bulbs but they are out of stock at the moment. It's so annoying as I'm having to do everything by candle light and they burn down quick when that is your only source of light! I had a really bad day today, felt so disappointed at the state of the flat and couldn't ever imagine it feeling like my home. Just really wanted my parents or a good mate to come and help me tidy and tell me we could do it. Instead I sent a little ranting text to Taz and felt so much better after (thank you!!). Sophie got in touch in the afternoon and invited Czar and I to the Mzoozoozoo not a zoo but a backpackers bar where all the muzingu seem to be. Really nice atmosphere and nice to meet all the other volunteersTuesday 15th FebruaryOK so today we had decided we would speak to the hospital and then go into town and set up bank accounts. So I get dressed open my bedroom door and Czar is in his suit and Drs coat!! So I put on my uniform and go to work!! I get put in the Chief Nursing Officers office and she calls the paediatric matron to come and show me around. So she takes me around the hospital and shows me everywhere and introduces me to literally everyone!! We eventually got to the paediatric ward and fucking hell is it scary, there was one child in their HDU who was so malnourished it was crazy looked just like those Oxfam famine adverts you see all the time at home!! To give you an idea of the ward as obviously I can't take photos this is a 30 bedded unit that now has 70 beds but today had 110 patients!! You actually cannot swing a cat (or baby for that matter!) without smacking at least 5 people in the head... before I had too long to stress myself out bumped into Czar who kind of demanded that we leave to go and set up our bank account. We never did manage to set up a bank account today we have to go back.Wednesday 16th February 1st day as a NesiOK so the day shift 'starts' at 7.30 so I arrive at 7.20 because I'm me! I then proceed to sit on a chair until 8am when everyone has arrived. Then the nurses hand over and walk round although they only hand over certain patients the ones that there is something important to say on I think. They then have a main handover for everybody, although again they only mention the sick kids. Once that is over at around 8.30 the nurses go off and clean stuff! Sounds rubbish but there are no mosquito screens on the window so by morning the ward is riddled with dead or half dead mosquitoes and other flying insects!! I was sent to work in HDU as this is the area I'd be most comfortable.... well....HDU comprises 6/7 beds and a large table in the middle with a box with all the emergency equipment and a box with all the drugs in, mainly these drugs are out of date and many of them are open and then given to more than one patient but the hospital simply can't afford to buy that many drugs so it's share a vial over maybe a day and 10 children benefit or use the vial once and only one child benefits!! I say 7 beds but there were actually 11 patients. So once we'd cleaned we waited for the doctors to do the round. We notice that one of our patients with cerebral malaria was due quinine at 7am so we give that, the only way we know this is from a bit of tape stuck on the infusion bag that the drugs were in which states it was a loading dose of quinine so you give the 2nd dose after 12 hours. All children with malaria have empty IV bags clamped but still attached so they can be given the next dose. The doctors eventually turn up at 11, they do a very quick ward round and then vanish.I am then informed that the nurses split their lunches into two shifts one 12-13.30 the other 13.30-15.00, I'm going first so we leave without handing over to anyone although I'm told a nurse will 'cover' us. I return at 13.30 and another nurse IS covering HDU but because there are two new admissions both with malaria and anaemia. We attempt to stabilize the first who has an Hb of 1.6 and a BM of 1.7 (sorry for the non medical people basically really not good!!). The child weighs 13kgs so we give 65mls 10% dextrose which we first have to make using water for injection and vials of 50% dextrose so we then give that and the patient looks totally clapped out and is barely breathing, we then try to give 20mls/kg resus fluids but the way this works is just kind of letting it run. They normally count the drops basically 15 drops = 1 ml but that only works if they need to run like 180mls over 3 hrs so you want 180mls in 180 mins which would then be 15 drops a min! There is also no way of monitoring how much fluid the child has had aside from looking at the 200ml markings down the side! In all this time no one has actually written down any observations on any of these children. The nurses spend a lot of time at the nurses station and seem to totally lack morale and interest!Oh I forgot to mention the best parts of the day, basically there is one bathroom on the ward which the nurses use to get water for cleaning so none of the parents wash .... oh yeah imagine the smell. Due to space constraints they also don't isolate children with diarrhoea or vomiting so that adds to the wonderful aroma. There was also a rat running around HDU today, it was huge and loads of flies land on the children, just horrible.Thursday 17th FebruaryIn the morning the nurses do a quick walk around and then we went to the meeting. Someone had a live chicken on the floor in the coffee room for her dinner that night! Now that's Malawi!! The idea is that once the doctors are done the nurses are then allocated to work in specific areas, one to do HDU, one to do the medical ward round, one for the surgical ward round, one to do drugs and dressings and the other for admissions.So I worked in HDU again today. I was left to my own devises in the morning, which up until 10am was quite nice as I managed to get on and do observations on everyone and clean everything. I noticed the nurses do a lot of faffing (this is now my technical term I think I'll be using it a lot!!) around at the nurses station. So I went over and asked about the drugs and how you know what time drugs are due as the doctors don't prescribe them they just write x-pen (penicillin)and then TDS. She didn't really understand what I was talking about and went on to explain about the emergency drugs they should have in HDU and how she thinks it should be organised ect. So we arranged that and then I did some 12pm obs. I then went for my lunch and asked whether it really was an hour and a half for lunch and she said no it is meant to be an hour but you are supposed to get a 30 min coffee break in the morning!So I am back on the ward at about 13.20 and sit in the staff room then go back out at 13.30. we head back into HDU and I start to do some obs then I am told one of our patients who I've been very worried about is going to theatre she grabbed my arm and kept screaming Niwopa (I'm scared) so in my best Chitumbuka I said kuwopa yayi (don't be scared!).There were lots of admissions this afternoon so we had to leave HDU to help, basically when children are referred they often only come with their medical passport (like a red book but clinicians write diagnosis and treatment in) so the nurses have to cannulate each patient and send bloods, if the child looks anaemic they can do a bedside Hb. They then do a random blood sugar if the child appears malnourished or lethargic. If the RBS is low the nurses will then make up 10%, then they just push the fluids and then find a bed if your lucky if not then they get a mattress out from the store room and find you a bit of floor!One of our patients had severe malaria and malnourishment he hadn't eaten for about 10 days. He weighs 15kgs and is 8! He started fitting again this afternoon so the nurses gave him some rectal diazepam the nurses just do everything here the doctors don't even prescribe the drugs and the nurses don't get them checked by anyone! They decided to put an NG tube down at the end of the day to try and give him some nutrition but the nurse literally explained it to the mother in about 30 seconds and then the mother is expected to continue on with the NG feeding herself!! Eeek!!!!!Friday 18th FebruarySo Czar woke me at 4am!! He clearly doesn't know how much of a grumpy bitch I am, he woke me because HE couldn't sleep and didn't know what to do!! I tried my best to be sympathetic but in the end said go and read a book or listen to some music.... Jesus!So then I got up at 6.15 and went to have a shower and our shower has a mixer tap and one of those things in the middle so you pull it up for the tap and push it down for the shower (get it? Maybe I'll upload a photo) and it's only one tap so you twist it left for hot water (although we are yet to experience any of this) and right for cold. So I lift up the tap to make the water run and the tap comes off in my hand!!! Unfortunately water is now gushing out of everywhere and I can't get it to stop. I eventually manage to get the water to stop pouring out of the tap and get dressed and go and speak to the guard. The guard says he'll see what he can do, which means you'll have to nag me more than that!So off I go to work.Arrive at work at 7.20 and there is no-one around by 7.40 the 1st of the day shift turn up. The night guys finish up what they are doing and hand over the patients they consider to be sick, which scarily doesn't include all the HDU bay?! So then he vanishes at 8am fair enough that's when they are meant to finish so I go into the staff room to get drs handover and there are no nurses in there, so I head out to find them. There are now 3 of the 5 nurses present who are chatting away, laughing and howling. I go back into the Drs handover and listen, by the time they finish at 8.50 all of the day staff have now arrived. The ward have teaching on Friday so all of us stay in the handover room and have some teaching by an HIV/AIDS nurse which was really interesting but I couldn't really concentrate as I was aware the ward now had no nurses!!So we leave the room by about 9.40 and start Dr's round, the nurses are allocated again to specific tasks and then the nurses start ordering drugs, I don't really understand why this has to be done now. So the Drs have seen a lot of the patients before the nurses are even away from the nurses station. At this point Czar came up to me and said the hospital administrator spoke to him and said we have to set up bank accounts today and they will write us a letter. I speak to the nurse in charge and having already told her I have a meeting this afternoon I now say I need to leave now. She doesn't even seem bothered but I feel incredibly guilty, I have a brief chat with her as I didn't start my orientation till Wednesday so still have 2 days of the week on HDU and just want to check she wants me to do them and not go straight somewhere else. She doesn't really care but says yeah you ought to finish the week.Anyway we then get driven by the hospital to the bank. Setting up a bank account is relatively easy in Malawi but at the moment I don't have a work visa I have a 30 day business visa so they weren't happy to give us bank accounts. So anyway after a lot of faffing and two brief power cuts we have a bank account. I have to go back to the bank in about 2 weeks to collect my ATM card! By the time we are done it is 1400 and I'm meant to be meeting another VSO volunteer who did a similar job to me. It was really nice to meet up with both of the other nursing volunteers as they have both been in a similar position and were really helpful. They explained that some things you aren't going to be able to change, the dirt, the mosquitoes and the amount of patients to nurses. But they did say to discuss in depth with the matron about exactly what she wants me to do and explain that I'm not there just to fill nursing job and don't want to be treated like I am. The girls also said not to hold out much hope of being given an office but said the best way to do it might be to suggest that Czar and I share an office. That means I will be able to be away from the wards and doing some work but not at home, as being at home looks bad even if I purely am doing work!I think the orientation is going to be difficult but I'll get there. I'm looking forward to seeing the nursery/NICU which takes babies up to 6 weeks. Now I have the whole weekend off to go food shopping, see about buying a dongle or some form of internet connection and give this house a bloody good scrubbing!!Oh BTW I now have light in my bedroom, I spoke to my friendly neighbour who said it is only 450KW to buy a florescent light bulb which is just under£2 so I thought why not, if I wait for them to do it I'll spend more than that on candles. I've had a couple of moments when I've really missed home this week, I also had a horrible moment where I missed PICU!! It tends to come in waves and so far I'm fine but you just suddenly have moments when you go “fuck I'm in Malawi!”I burnt my shoulder in the 1st week in Lilongwe and it's now all peeling off so I'm looking ultra attractive!! I'm going to try and start writing to all the people that I promised I would soon, just trying to find my feet I haven't forgotten about you!!This picture is of Czar and I with some of the northern region volunteers at the Mzoozoozoo!!