Goodbye, Lilongwe!

Hard to believe that a month has passed since we left the US, but indeed it has.  We start the ~40 hour trip home tomorrow!

We had our last day at the hospital yesterday.  Somewhat appropriately, our day was spent rounding in a new part of the hospital, Children’s Ward B, the area where the patients needing a longer hospital stay end up.  As we found, their hospital stay is often a bit longer than actually needed… There seems to be somewhat of a tendency to just “continue therapy” on these kids without really thinking about their progress or the accuracy of their diagnosis.  A few examples: Meghan discharged a kiddo who’d been in for over 2 weeks on IV antibiotics with what was likely bronchiolitis and who now looked like a peach, and I changed the diagnosis on a 13 year old boy from “trypanosomiasis” (African Sleeping Sickness) to “normal teenage sleeping pattern,” counseled Mom, and sent him back on home after a 7 day hospitalization.  We saw some of the TB kids as well and were able to sent one super cute little baby with milliary TB home to finish out her course of drugs, much to her mother’s pleasure.  All in all, it was a nice, fairly relaxed way to round out the month at KCH.

After our work was done, we took a little side trip to Dedza, a small town about 90 kilometers from Lilongwe.  The town is up in the mountains, so we had lovely scenery to enjoy on the way (not to mention great roads – always a welcome treat here!).  There’s a nice lodge in town that specialized in pottery, so we spent some time browsing the shop there, walked around their grounds a bit, and had a little dessert before heading back to the city.

Today was a day off to spend a last bit of time around town and to get our packing done.  Turns out today is actually a holiday, May Day (like Labor Day), so things were a little quieter than usual.  We slept in (hooray!) this morning, then had lunch with a lovely neighboring family we met earlier in the month.  After lunch we went back to Ama Khofi, a nice little coffee shop/cafe we found earlier this month in a nice part of Lilongwe.  We got dessert and used up the last of our Kwacha (Malawian currency) on a few things from the small shop there.  We took one last walk in our part of the city this afternoon and are now in for the night, wrapping up packing for home.

Our first flight leaves just after 1pm local time tomorrow, and I finally make it back to Memphis around 9:30 Friday night.  The itinerary: Lilongwe -> Blantyre (no change of plane) -> Addis Ababa -> Rome (no change of plane) -> DC -> Cincinnati -> DC -> Memphis.  Going home is always bittersweet, and this time is no exception, but I’m ready to be back in Tennessee!  This will likely be my last post from here in Malawi, but I’ll try to get a few more pictures and some final reflections up in the coming days.  Don’t stop reading just yet!  🙂

Weekend at the Lake

Well we couldn’t exactly come to a country known for it’s beautiful lake (3rd largest and 2nd deepest in Africa) without paying said lake a visit!  We set off last Friday after work for Lake Malawi and Nkhotakota, a small town on the lake located about 2-3 hours from Lilongwe.  We never actually made it into town though, instead spending our time at Nkhotakota Safari Lodge, a small lodge just  the the south and right on the beach.  Here are a few photos of our accommodations – simple, but certainly sufficient, and practically luxury by Malawian standards.

Beautiful Lake Malawi was right outside our front doorsteps.  It really felt more like the ocean than a lake – big waves, tides, no other land visible except the very distant mountains of Mozambique.  We spent most of the day Saturday reading on the beach with the occasional dip in the water to cool off.  We also took a long walk around the bay, during which we seemed to be the only ones walking north.  Tons of locals were heading southbound, presumably for some sort of event (football, perhaps?) – we were asked a number of times “What is your name?” and “Where are you going?”  I think those must be commonly taught English phrases!  People seemed a bit perplexed that we were just out for a walk, which makes sense in a culture where walking in a main means of transport rather than just something to do on a pretty afternoon.

While relaxing in virtual solitude (seriously, there were hardly any other guests at the lodge or its next door neighbor), we were interrupted by a large group of children, ranging from preschoolers to teenagers, apparently having a group day at the beach.  It might have been a bit annoying if they weren’t so adorable and excited!  After a few minutes of flipping and jumping and kicking in the sand, most of the kids headed for the water in various states of undress.  It was too cute to watch the little girls in their fancy princess dresses try to figure out how to manage the whole situation.  The boys in these photos were doing flips off of the concrete wall – they were pretty good!

Overall, it was a wonderfully relaxing weekend.  We got to sleep in for the first time all month and basically had no agenda to follow at all.  A lovely last getaway for the month.  We’ll finish up work tomorrow and have one last day here in Lilongwe before we head for the US on Thursday!  I’ll try to get another post up before we leave about our last little Malawian adventures.

P.S. Apologies for the poor photo layout – wordpress is not being so friendly tonight!

Back to work!

We’ve been back to work this week, despite all the safari info I’ve been posting!  Things have definitely been different without Hans, the primary attending we worked with the first half of the trip, around.  On the one hand we have been able to see some different areas of the hospital which has been nice, but on the other hand it was kind of nice at times to have someone “in charge” of us.  All that being said, we’ve had some good experiences. 

Meghan and I each spent time with the oncologist here and got a better picture of oncology in Africa.  Like most everything, it’s a whole different world.  Compared to the detailed diagnostic testing and the complex protocols we have at home, things are much more simplistic.  Diagnosis is based on clinical presentation, HIV status, FNA, and maybe biopsy with relatively limited pathology analysis.  Treatment is some combination of the around 5 drugs they have to chose from.  All things considered, the oncologist from the US who is here currently has made great strides in treatment of kiddos with cancer in this area.  He is heading back to the US this summer and is training a pair of local clinical officers (like a PA) to run the show once he’s gone.  It’s really incredible the volume of children these guys are managing with so few staff, especially when you compare it to home.

The last few days we have been at the Baylor Clinic next door to KCH, part of Baylor’s International Pediatric AIDS Initiative.  The clinic may be directly next door to KCH, even connected by a covered walkway, but it’s like you’re in a different country.  The clinic is clean and modern.  There’s very organized, structured patient flow.  There aren’t any bugs (that I saw at least).  There’s (supposedly) air conditioning, though it’s broken at the moment.  It’s just amazing that the two places exist side by side.  The Baylor clinic follows a huge number of the HIV infected or exposed children in Lilongwe and the surrounding area and provides all of their HIV related care as well as “sick visits.” Even in just two days I learned a lot about HIV care in resource-limited settings and saw first hand some of the challenges that these areas face.  It was also just really nice to get back into a clinic environment for a few days and to be in a setting that’s a little more open for longer conversations, more questions, and more in depth patient interactions.  While I definitely enjoy inpatient medicine and have definitely learned a ton at KCH, I like clinic as well at times. It was good to add this experience into our Malawian mix.

We’re back at KCH tomorrow, but only for the day – we’re heading to Lake Malawi this weekend for some sun and relaxation!  My photo burden may not be as large after this trip as it was after safari, but I fully expect to have a few new things to post.  We’ll be heading back to Lilongwe on Sunday, so no more posts until then at the earliest… and then just a few days until we’re US bound once again!  Thanks again for reading and for all the lovely comments from home. 🙂

Safari Alphabet – the Finale

On the home stretch! (of this series of post and of this month, really)

R is for Rabbit HaRe
This little guy is a scrub hare, one of our fun nighttime finds.  I’ve mentioned our nighttime drives before, but I thought this would be a good time to give a better picture.  We headed out at about 4:00 for the evening/night drive.  The sun sets around 5:30, and by 6 it’s thoroughly dark.  Once dark had fallen, our trusty spotter George would pull out his handheld spotlight.  He would stand in the passenger seat while Gandwe drove slowly, scanning back and forth with the light for any signs of animals – eyes, movement, etc.  Most of the eyes we saw belonged to impala, puku, etc, but from time to time we’d spot fun nocturnal critters as well.  Thankfully the spotlight was bright enough and we were often close enough that I could get decent photos even at night.  (By decent I mean you can identify the animal… ha).

S is for Squirrel
Those who know me well may know of my unusual affinity for squirrels.  You can imagine my excitement, then, when we saw our first African squirrel, a tree squirrel!  (There is another species of squirrel found in the park, the sun squirrel, but we didn’t see one of these.)

T is for Tents and Tea Time
As we were going the budget safari route for this trip we opted to stay in the camp’s tents (as noted in the story of the great hippo encounter).   They weren’t quite as rustic as it sounds, as we did have beds inside and an electric lamp, but we certainly got the outdoorsy safari experience.  Another big part of the camp experience was tea time.  Despite it being quite warm, we had tea or coffee after each meal as well as during our rest stop on the morning drive and prior to leaving for the evening drive.  I haven’t had so much tea in a day in my life.   There was certainly no lack of food/drink provided!

U is for Under the Stars
Here’s a look at a few more of the animals/birds we encountered on our night time drive, including (clockwise from top left) genet, scops owl, civet, and mongoose.  Night drives also gave us the chance to see the beautiful stars in the wide open African sky.  We were able to identify the southern cross, orion, and one of the dippers with our limited astronomy knowledge, but I’m sure there were many more visible to the trained eye!  Such a magical feeling to be in the park after dark.

V is for Vulture
Not the cutest/prettiest of creatures, but as scavengers they certainly have their place in the “circle of life.”  That and it starts with a V.  Not many things do.  Just saying.

W is for Warthog
I think these guys were some of the most fun animals we saw, and there were many a spontaneous outburst of “Hakuna Matata” when we came across them.  They most certainly fall into the “so ugly they’re cute” category!

Fun fact: Warthogs have a bit of a design flaw… Their necks and snouts are such that in order to reach the ground to eat or drink they have to kneel down on their front legs.  Somehow it only makes them more endearing!

X is for EXcellent Company
Since there are absolutely no pictures of me anywhere in my Africa posts thus far, I figured it was time to add one!  Plus nothing starts with X.  I have, however, had excellent company indeed!  Meghan and I are racking up quite the list of countries together, and I couldn’t ask for a better travel partner! (And you know you love the safari hats!)

Y is for yellow Little Bee Eater
These little guys were cute, and this particular one was even eating a bee!  The picture isn’t the greatest, but trust me, there’s a bee in there.  Still amazed at how beautiful the birds were! Except the vultures.  Not so beautiful.

Z is for Zebra
Definitely one of the classic safari animals and a great way to round out the list!  These guys basically just look like fairly small, very stripey horses.  You could always tell who the males were in the group as they would stand very still and stare us down until they decided we weren’t a threat.  The females just kept on eating, content to let the men be the vigilant ones.  Come on ladies, gotta stand up for yourselves!

Fun fact: Zebras hide their new babies in the bush until they’re about 4 weeks old before introducing them to the rest of the family.  This helps ensure they stay protected during their most vulnerable period. 

Well there you have it!  This was definitely a fun way for me to document my safari experience, and I hope it was entertaining to those who are reading!  I swear I am actually working still… Next post will update on the events of the week from that standpoint.

Safari Alphabet, Part 2/3

This time we’ll just jump right in!

J is for Jilted Lovers
As I mentioned last time, the impalas were every present and usually quite entertaining. Impalas congregate in two kinds of groups groups – a harem which consists of one male and a number of females, or a bachelor group of males together.  In the harems, the male will frequently chose a female whose… affections… he wants to pursue.  We watched a rather persistent male impala do his best to catch his lady friend one morning, but to no avail.  Couldn’t help but feel a little bad for the guy.

K is for Keeping Cool
Although the daytime temperatures were not all that much hotter than in Lilongwe, it felt much warmer.  Luckily the camp was prepared for this!  First, we did our drives in the cooler parts of the day.  Our AM drive left camp at 6:00 (after a 5:30 breakfast – yikes!) and returned around 10:30.  Our evening drive departed at 4:00 and returned at 8:00.  This was for practical purposes as well as for our comfort – the animals don’t want to be any more active in the heat of the day than we do!  During the afternoons, we spent our time in the camp’s pool, which overlooks the river, and in whatever shady spot we could find, usually reading and trying not to move too much.

L is for Leopard
We were oh so fortunate to see not 1, but 3 leopards during our drives!  Two of the sightings were at night, and the third was from a distance at dusk.  The first literally crossed the road directly in front of our safari vehicle – I never would have thought we would get that close!  Our second nighttime sighting was of an actively hunting leopard.  There were impalas not far away that he was clearly stalking.  We could only stay a moment lest we disturb his process.

M is for Monkey
In addition to hippos and impallas, monkeys were among our most commonly encountered animals.  A large group seemed to take a “what’s yours is mine” attitude at the camp, sharing our pool area, gym equipment, et cetera.  I think they would have gladly shared our tent as well had we neglected to secure the door!

N is for Nighttime Visitors
As I’ve mentioned, there was no shortage of hippos in SLNP and around our camp!  We were informed on arrival that, at times, the hippos who populate the river our camp overlooks may come up into the camp itself at night to feed.  We had a watchman in place to guide us to and from places after dark and, presumably, to protect us from any rogue hippos in the night.  I must say, while Festo the watchman seemed nice enough, I don’t think a rogue hippo would be intimidated by his flip-flops and flashlight.  Our first night I awoke at about 12:30 to a loud, odd crunching type sound next to my head.  After a few minutes of disorientation, I realized that it had to be a hippo munching on the grass.  Right next to my tent.  Adrenaline kicked in and I froze, afraid that if I lifted my head to see out of the mesh part of the tent he would see me and eat me (never mind that hippos are herbivores).  To give you an idea of how close he really was, there was a tent next to ours, about 6-8 feet away.  A full size hippo was standing in the space in between.  Yeah.  He eventually made his way around to the back of the tent and I finally got up the nerve to lift my head ever so slightly.  There was just enough light from some distant bulbs to make out a clear hippo silhouette.  After my heart finally calmed down, I decided he seemed pretty content to eat his grass and eventually fell back asleep.  (Of note, Meghan slept through this whole event.  Based on the next morning’s breakfast convo, I think she was the only one!)

Fun fact: A group of hippos is called a raft!

O is for Open Air
So unfortunately it seems that I neglected to take a photo of our safari vehicle.  The photo below, which is not our vehicle, or even our company, is a pretty good representation.  The driver sits in front with 3 elevated rows of seats behind him.  By some stroke of luck we ended up in the front seat on each drive, though I think the view from all seats was quite excellent.  The open top made sun protection a challenge, especially in the later hours of the morning drive, but we managed to escape without any significant burning thanks to loads of sunscreen and lovely safari hats provided by the camp.  And what it lacked in protection, it made up for in wide open, unobstructed views.  This is also a good time to mention how few other vehicles we saw during our drive.  I would guess we saw maybe 10 others each time, in a 4 hour period, mostly near the entrance to the park.  There were hours where our lone truck was  completely alone with the animals.  Such a remarkable experience.

P is for Puku
In addition to the impalas, there were a number of other antelope type animals around, including the puku.

Q is for Quirky Behavior
Boy, the letters get harder toward the last 3rd of the alphabet!  But we did indeed see some quirky animal behaviors.  In particular, we watched a highly entertaining display by a pair of hippos having a tiff over territory.  Ways that hippos show their dominance include opening and snapping shut their wide jaws (logical, right) as well as pooping.  Yep.  In order to show the other guy who’s boss, they poop while wildly shaking their tails to fling the poop as far as possible.  I think our group found it more hilarious than intimidating, but what do we know?  Our friends eventually settled their little spat fairly peacefully and went their  separate ways, but not before they made sure to demonstrate their poo flinging abilities.

And that’s it for now!  Stay tuned for the conclusion of our series tomorrow (hopefully).

Safari Alphabet, Part 1/3

So in an effort to find an interesting way to talk about my safari adventure without just babbling on and on, I came up with the idea of making an alphabet.  There may be some stretches to make it all come together, so just roll with it. 🙂  First, just a brief description of our trip.  We traveled from Lilongwe to South Luangwa National Park (SLNP) in Zambia with Kiboko Safaris.  We stayed at the Track and Trail Safari Camp just outside the entrance to the park where they provided our accommodations and all of our meals.  Our guide stayed with us as well and was always around to answer questions and tell fun stories. Our first evening was mostly spent relaxing after a long drive.  Each of the next two days we took a morning and evening game drive, 4 hours each, with more relaxing in the middle.   After two long hard days of animal spotting ( 😉 ) we headed back to Lilongwe Sunday morning.  So all that being said, here goes nothing!

A is for African Elephant
We saw elephants galore during the safari, some solo, some in groups.  While the elephants in South Luangwa NP are smaller than in some other locations in Africa, their size is still intimidating.  We were so fortunate to come within feet of these beautiful creatures!

Fun fact: A group of elephants is called a parade! 

B is for Cape Buffalo
We only found these guys on our second day.  Per our knowledgeable guide Gandwe, they are actually the most dangerous animals in the park.  Unlike most other species which give a warning signal when they feel threatened or defensive, the cape buffalo can turn on you in an instant.  These guys didn’t look too happy with us most of the time, but I think that’s just their natural facial expression…

Fun fact: When cape buffalo become old and unable to keep up with the herd, they separate themselves and live solo for the remainder of their days.  They are especially dangerous during this period.

C is for Colorful Birds
SLNP is a birder’s paradise.  We saw dozens of different species during our visit, and we only scratched the surface of the full list.  Everything from beautiful brightly colored songbirds, to egrets, to owls!

D is for Dirt Roads

The trip to Zambia was longer than I realized when we planned this trip!  It took us about 7.5 hours to get there (though the trip back was a bit quicker as we didn’t have to make as many stops.) The roads in Malawi aren’t too terrible, but once you hit Zambia there is a huge section leading up to the park that is largely unpaved.  I’d say at least the last 2-3 hours of the drive was along dirt roads filled with potholes.  I can’t say it was the most comfortable trip, but it was certainly an experience!

E is for Eagle
We saw a number of different species of eagles on this trip as well, including the African Fishing Eagle, the National Bird of Zambia.  I thought I had a photo of one, but I can’t seem to dig it up this evening.  This picture is not of an African Fishing Eagle, but it is of an eagle!

F is for Fawns and Foals (aka babies)
There were babies all over SLNP!  So precious. I have no idea what these baby animals are called, but fawns and foals fit the letter.  Like I said, just roll with it, and enjoy the cuteness.

G is for Giraffe
We were worried when we didn’t find giraffes close up on our first game drives, but we needn’t have stressed – once we found them they were everywhere!  Such strange, beautiful, and awkward creatures.  There were even babies around (as obviously pictured above), one young enough to still have the remnants of his (her?) umbilical cord.

Fun fact: Giraffes typically sleep standing up, but they do sometimes twist their long necks around and rest their heads on their back!  Oh to have that kind of flexibility!

H is for Hyena
Such creepy animals!  We saw a number of these, but only on our night drives (hence the photo quality.)  Their movements and stature is so characteristic – that hunched over, stalking appearance.  Just like in the Lion King!

Fun fact: A group of hyenas is called a clan or a cackle – I personally prefer the latter!

I is for Impala
I was so excited when we saw our first impala – little did I know we would see hundreds over the course of our drives!  Impalas certainly seem to be thriving in SLNP, and even after we had seen herd after herd they didn’t cease to amaze.  Such graceful, powerful creatures! 

To be continued…

S is for Safari

We’re safely home from Zambia and settling back into the house.  Our safari was beyond amazing.  I can’t even explain how blessed and fortunate I feel to have the opportunity to be in this place, see these sights, and have these experiences.  I took over 1000 photos (seriously) and will have a lot of work ahead of me at home to get things sorted and organized.  In the meantime, I’m working to pull a few of my obvious favorites to quickly edit and post on here.  I have an idea for my next post, complete with many more details of our adventure, but in the meantime, a few teaser photos!

Baby elephant and mama.

Contemplative monkey.

 

Please check back soon for more!  Going to try my best to have more up tomorrow, if not sooner.

Safari Time!

We finished our longest consecutive stretch of work days for the month today – 10 days.  I was back in the post-natal high risk nursery (the NICU, basically) for the morning, then a bit of med student teaching this afternoon.  Not a bad way to end the week.  I took a few more photos today which I’ll try to get up before too long.  It was our last day today with Hans, the primary attending who we’ve been working with.  He’s going to be out the next two weeks on vacation (which based on the hours we’ve seen him work is very much deserved).  Next week will definitely be different without him around, but we’ve come up with a plan to explore some other parts of the hospital that we haven’t had a chance to see yet. 

We decided to leave the hospital for lunch today and run some errands.  We finally got to the vegetable market (we’ve been struggling, as it’s almost always dark when we leave the hospital) and managed to add some greenery to our diet!  It was about time.  We had a lovely veggie dinner tonight of green beans, broccoli, and potatoes and spent time prepping for our trip tomorrow. 

We leave bright and early tomorrow morning for Zambia and will be gone through Sunday.  No internet access there (I don’t think at least), so don’t expect any blogging for the next few days, but I’ll try to get a post up soon after we return.  I’m hoping for some great photo ops! 

I also wanted to say thanks to those who have been keeping up with the blog and for the comments from home.  I don’t always have a chance to respond individually, but it’s nice to know there’s someone out there reading and always good to hear from familiar “voices.”  🙂

KCH in Pictures (aka I’m too tired to write much tonight)

Another day done.  As usual, our best laid plans to leave a bit earlier today were foiled by the predictable influx of new sick kiddos at 4:00 (which is the time the “clinic” area of the hospital closes).  Not feeling up for many words tonight, so I’ll just get a few pictures up.  Excuse the quality – my iphone does better sometimes than others… Will hopefully have a chance before the month is up to go take a few shots with my real camera, but we shall see.

Anyway, for your viewing pleasure (and in no particular order)…

Cute baby and her mama in the nursery

The often mentioned EZ, as viewed from the front of the room.  Note the middle station full of drugs, needles and syringes, tubes, lancets, etc, all just hanging out in the open.

Kiddos in the courtyard area outside the EZ after bath time.  The big bellied little guy has severe nephrotic syndrome with ascites.

CPAP, Malawian style.  Basically (for those who care) you just have a set of nasal prongs and tubing with one end connected to the oxygen tank or concentrator and one end placed in a bottle of normal saline with the top cut out, the end of the tube about 5cm under water.  Then you use tons of plaster (tape) to make sure you keep a good seal (evidenced by the water in your saline bottle bubbling.)  Sadly, this kiddo has severe tricuspid atresia, which is inoperable in this setting.  Later than night his mom decided to take him home.

A pretty typical scene in the EZ.  A family hanging out on the floor, eating lunch (or whatever meal this was).  Note the non-functional sink at the top – the only sink in the EZ mind you.

That’s it for now.  Hope this helps give a slightly better image of all the places I keep mentioning!  One more day until safari!!

Long day

So today was another long one.  We didn’t really plan for it to be, but when we were still neck deep in work at 5:30 we decided we may as well get it done for the week!  So this will be short, but I wanted to post something at least.

Yesterday was not quite as we’d planned (why we continue planning at all at this point, I’m not entirely sure 😉 ), but it was alright.  We ended up working until about 3, a long day for a weekend.  We took a rather fruitless walk again that afternoon, but the weather was still beautiful.  We did learn that nearly everything in Lilongwe is closed on Sunday, as far as grocery stores, butchers, etc.  There was, however, one pharmacy open so we were at least able to pick up thermometers (it’s very useful to be able to take your own vital signs at work, as there usually either are none recorded, or those that are there are a bit suspicious).  We had dinner out (again… never planned to eat out so much while we were here, but we’ve found some great food!) and turned in early. 

Today, as noted above, was fairly busy.  We ended up as lunch cover in the EZ, so we didn’t get lunch until about 2:30.  By then we were a bit delirious and likely hypoglycemic, but our daily coke (glass bottle) helped a bit.  As above, the afternoon drug on longer than expected, so we just stuck it out for a late one.  Our attending actually seemed to notice and appreciate that we had stayed around, so that was encouraging.

Sorry this one is pretty short tonight.  Need to try to get some sleep for another full day tomorrow.  Will really try to get some more pictures on soon!