A reasonable man in Africa

- Our local restauranteur - a bit of a character!




Dr Leafy reporting back. Apologies for the delay. Where to begin?

All good, and very promising. Settling into Lilongwe social life and work is interesting.

Lilongwe itself is a strange enough place, for a capital city. It is one of those artificial towns, having been created as a capital for the new republic of Malawi. Therefore there is neither very little colonial architecture nor signs of the ancient alongside the new. Just the absolutely poor and decrepid alongside the new.

It is spread out, in the vein of a sprawling American city - that is where the similarities end. Lilongwe gives the feeling of being in the suburbs, or in a small sized county Carlow town for 90% of the time. The main roads link these sprawling randomly assorted numbered "Areas" (districts). What strikes me as most unusual for a city is that it is very rare for a shop/house/business/anything to be down at the roadside. Usually the roads are sided by a dirt pavement and trees. Buildings are very much set back from it, often in complexes. There is one small city centre area which is what you might expect (if you had very low expectations). It does feel more like it is from the era of A Good Man in Africa. Google maps demonstrate 1 forking road - like a mercedes sign. Not a fair representation.

There are plenty of ex-pat bars and restaurants (well - maybe not plenty, but a few, enough to go a week or so without having to return). I usually have lunch in the local market set up beside the hospital. It caters for the hospital and university crew - I'm sure a few of you saw the photos. It is pretty ramshackle, to put it politely, but the food is excellent - I have paid huge money in Dublin for meals I enjoy far less - the Grilled Chicken special (flame-grilled chicken, killed that same day, with veggies, sauce and Nsima (local stodge/starch dish which is a cross between mashed potatoe, porridge and dirt) is to drool over. This lunch sets you back about 75 cents. To my great delight I found a cafe there today: the back of the market has a coffee shop with cappucino advertised on a chalk board outside. It is a hut, not unlike one I found once in northern India (1998) halfway up a Himalayan foothill, with a tin roof, dirt floor and stone bench. Unfortunately he is out of coffee, tea, milk, water, sugar and fire. He advised me to come back in a week or so, but was very happy with my promised custom.The shops seen in the picture sell all the necessary groceries, at a basic level. I usually go to the big western supermarket chain a mile away, to be honest, though.

Evening meals are either cooked at home in our nice digs, or in one of the aforementioned restaurants. Some great food, very cheap. Someone must have lied to me coming out here that I would lose 15 kilos. I'll be lucky if I break even. [that said, I have yet to crack into the local soccer scene - 5-a-side on Tuesdays in the British High Commission, and Sunday league 11-a-side; and I have yet to become acquainted with the local parasitological fauna, I think]

The accommodation is good - it is like living in an American dormitory house near the hospital - for the summer it will be very full with ins and outs of elective students from the University of N Carolina. There are a couple of more long stayers like me, but most are here for a month or 2 at a time. The plus side is that tt is great having people to hang out with and chat to for now. The down side is that things can get a little crowded. Because I am more permanent I don't have to share a room, which is a nice plus. We have a car or 2 (depending on availablity from the University Project) to share - vital.

Work is excellent - running the study into Cryptococcal Meningitis in Kamuzu Central Hospital. I have a team of a nurse, clinical officer (a medical career which has no Irish equivalent - they choose not to finish the last 2 years med school, so work as doctors, but cannot progress beyond intern level, and do no call), and a domestic aid. We are responsible for the cryptococcal study, with that as primary responsibility. We also round with the medics when free, and help out, primarily with cryptococcal patients that didn;t meet our study criteria, and with other stray outpatients (i.e. those that stroll up with a complaint and find you instead of attending the A/E, ward, or OPD - there is a method to the madness, as well as decided madness to the method - but I haven't figured it out yet).



The study patients are a sick bunch - about 40% of them die. We have had a bit of a lull over the past week, after a busy first week clinically - at least it gave me time to get organised, as you'll hear. The work will be part admin, part clinical, part lab based - with occasional covering in OPD clinics for the HIV clinics.

My first week I was auditted! Sounds worse than it was. The designer of my study protocol is an English SpR in ID, doing a PhD in Cape Town, in the same sort of research as this (big coincidence - his father is a public health doctor, and his grandfather was a medic in WW2 in N Africa - just like mine!). He came up to see me at the beginning of my stay and audit the project to date with one of the official project internal auditors from the UK. I was not really to blame for the (minor) faults, so I didn't take any flack. The project is in good shape really - but needed a big administrative-style shuffle: file compliation, paperwork, beaurocracy - no better man than Jackson for that sort of stuff. I have spent most of the week, when not doing LPs, running from Billy to Jack, getting certificates, proofs, documents and filing them in the Trial Masterfile - my creation this week. While my instinct is telling me to roll paper into a ball and throw it into the nearest muddy ditch, I am refraining and the Masterfile is taking shape. It may be the beginning of a new me ...?

The hospital is very under resourced - mainly from a diagnostic viewpoint. Most basic therapeutics are there, but you really feel the lack of decent radiology or serology. I hate to say it, but ... I'm sorry for all I said to/about any of you Radiologists, all is forgiven. There isn't even a CT scanner. For absolutely necessary cases (which by necessity cannot be vitally urgent) an ambulance brings them 4 hours away to Blantyre. It is often cancelled for myriad reasons, and only takes up to a maximum of 8 cases (where 10-20 a day could be sent, really, from medicine alone). There are 2 senior physicians running the medical side, with one new one to start soon. One is a Malawian of a similar age to me - a very likeable, good-natured, principled man. We get on well. The other is a super German physician who has lived in Africa for a long time. He is excellent too. There are dodgy interns and a few registrars too.

I'm getting tired so I'll switch to consice form:

Highlights so far:

Joining the local sailing club - a 30 minute drive away, mainly dirt roads. My first weekend in town, I was brought out to Lilongwe Sailing Club by a couple of friends - good fun. Arrive upon this small reservoir, a few km by a few km in size. Nice little "clubhouse" - very open plan with a large veranda overlooking the lake. To one side is a permanent barbeque. All it takes is a phone call to the caretaker, who will have boats ready for you. The boats are well maintained dinghys - Megan and I were in a Miracle - a 2 person boat. It was fantastic to be helming and zooming around in such a responsive toy. Great wind and great fun. The only words of warning prior to setting sail related to the local hippopotamous who has been implicated in the killing of a few fishermen! Like all good troublemakers, he hangs around at the corner - probably peddling dope too, I'll bet! We didn't see him. Joined for the rest of the year (unlimited access to the clubhouse, boats, sails, everything) - 14 euros!

Amazing/Strange experience: Going to a local African [non ex-pat] bar with friends - booming place - loud music, lots of beer, lots of drunk African men wanting to talk to the "Mizungus" [white people]. Absolute dive really. Heaving with people, any of the very few, non-Mizugu females present were there "on business" if you get my meaning. One of our friends (female) came back from the bathroom commenting on "how sweet it is to see all the kids making out outside the back". We pointed out the the walkway in question was the entrance to "Angel's Restrooms" [emblazoned on the wall in 4 foot, fancily painted letters] - the local brothel. Around the corner was the big nightclub - excellent fun - a mix of ex pats and Africans - an outdoors area not unlike Leggs, except the chicken is far better. I will get to know it better.

Last night went to the movie night being hosted in American Ann's house, in a distant suburb. I texted Ann saying I was running a little late - and arrived in with the Dundee students and 3 pizzas while the lights were down. We shuffled in and sat near the front of the living room, on the floor, in front of the wall/screen (the film projected up onto the whole wall of the room - excellent). Unfortunately the film was a quiet intense French artsy thing (excellent, if you're asking), so there was never an opportunity to open the pizzas and eat. So we sat starving beside steaming, but cooling food. Surprisingly when the lights came up I recognised noone (apart from the Dundee students), and found that I was in a room of strangers. The ex-pat group I had thought were hosting the night were not, and I introduced myself to a completely different American Ann than the one I had presumed. Kind of embarrassing/funny.

I was at the real lake Malawi too; local beer tastes great; weather is OK; all worth a comment but I've written too much.


Cheers,

Arthur