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1st glimpse of the Bottom

Posted Jan 27 2009 8:23pm
Yesterday, day 13 here in Malawi, I had my first glimpse of Bottom Hospital. I did not run away screaming but I am glad that I spent time at La Maternidad in Bolivia, and that so many people warned me about the conditions before hand. After I returned, Dr. Kaponda told me that she once took an American midwife there - who like myself intended to volunteer - but that evening, a Tuesday, she developed a headache and by Thursday she was on the plane back to the States. I’m sticking it out this week, we’ll talk later about next week : ).

Really, it is a place you must see to understand, perhaps once I’m a familiar face around the joint I’ll bring my camera and put pictures here but that will be later. The hospital itself is surprisingly small, considering it is the principal hospital for the entire central region. It actually consists of a cluster of buildings in various states of disrepair. There are male and female tuberculosis wards and male and female psychiatric wards (these wards are really just a simple one room building with about 20 or 30 beds), a small antenatal clinic, a voluntary HIV testing and counseling clinic (VIC), a polio clinic, and the maternity ward (including inpatient antenatal, an admission room, labor and delivery, postpartum, a kangaroo care room, neonatal, and the operating theatre (I love that term)).

Yesterday, apparently was a slow day for L&D, only six or seven women were in active labor when we walked in, two in second stage (pushing). The nurse greeted me, stepped aside to catch a baby and then returned to lead my tour. L&D itself is small, the size of a standard classroom. The room is painted in turquoise and old matching turquoise curtains hang between the beds, unfortunately not concealing much of anything. Each of the naked women on the bare plastic mattresses glanced up to catch my gaze as I passed through. A nurses’ station - consisting of a wooden bench, two sinks, a small refrigerator with emergency medications, and a cabinet (mostly empty) with delivery packs - divides the room, separating high risk from low risk laboring women. Near the nurses station sits the infamous broken suction machine, as well as two carts for newborns. Only one cart had a heat lamp, which did not seem to be on or working at the time we passed through, but warm or not, its small passenger was contentedly sucking on a fist.

The most impressive part, to me, were the large handwritten signs posted about the room on HIV transmission prevention, steps for managing postpartum hemorrhage, and the importance of hand-washing. Regardless of resources, it’s good to know that those are all priorities for staff. The staff I saw around the place were friendly to me and seemed to be kind to the women they were caring for (a good distinction between Bottom and La Materindad). Dr. Magete was also present and wanted to make sure I saw the suction machine.

Outside, people in bright clothes sitting on mats, or dirt, in spots of shade filled the grounds, eating, sleeping, talking, waiting. These, I was told, were the “guardians” of the patients. They stay to care for their hospitalized family members and to prepare their food in the outdoor communal kitchen located behind the psych ward. I believe the large presence of guardians exemplifies both the cultural importance placed on family as well as the nursing shortage.

My walk through lasted about an hour. I was supposed to return today for observation but we received a letter this morning from the hospital saying that they wanted something from the nurses and midwives council (NMC) before I begin observation. Unfortunately when we went to the NMC we received only a verbal “ok” so now I am here in the office again this afternoon. Paperwork paperwork blah. I suppose the good bit is that I’m sure doing a lot of journaling and those of you who are following probably know more detail about my day to day life than you ever imagined you would (I’m not sure if that’s good or burdensome for you).

Last night I went running with the expat Wednesday night running group. They are intense runners. It was work. The route was only about 6K, but it was on a dirt trail through the bush and in spite the terrain the leaders must have been going at a 7min/mi pace. It involved crossing a few muddy streams, running up hill for a long ways then down, beating through 6 ft high grass, and racing between rows of corn. If I hadn’t been thinking that I was near death for the entire run, it would have been really enjoyable. The sun was setting over the hill and there were flowers scattered among the corn, every now and then we would come upon some Malawians who would stop their work to smile and laugh at the m’zugus (white folk), and the children we passed stuck out their little hands in a line to be slapped as we ran by. I’ll do it again. I’ll look forward to getting in shape so I can keep up with the 40 and 50 year olds in the group (no joke). Only once we were all done did someone mention to me that there are venomous spitting snakes and pythons out there. Great. I’ll still do it again. I won’t be the leader so I figure I’ll be safe.

The expats, as a group, were really nice. I was among the youngest and definitely the newest arrival. I have to say that it felt really good to say, when people asked if I was visiting, “No, I just moved here.” I’m looking forward to developing community. In the group, I found a Brazilian who was so excited to speak Portuguese and already has planned outings for us, and a British woman who may have paying work for me down the line. Jennifer, the American nurse, dropped me off at home around 8. I was happy, happy for all the experiences of the day, for the potential of new friends, and the homey scene that greeted me when I returned – four women in the kitchen cooking, speaking Chichewa, and laughing.

Life is rich.
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