On becoming an ex-pat

Olympic tennis in the background [editor’s note – email obviously started a few days ago], wireless broadband dominating my foreground – the tropics aren’t quite as daunting as Heart of Darkness had me expecting. I sit here swiping at a few rogue mosquitoes and scratching Julep, the 3-month-old mongrel we have adopted in the guesthouse, who lies panting sleepily beside me.

I’ve settled in, to some degree. By many criteria in any case: head above water at work, regular football, tennis, rugby and sailing (I know, I know – how bloody ex-pat stereotypical!) regular parties, and making new friends.

There’s been a big flux of residents in the guest house. We now number 6, with more arriving soon. Great bunch, really.

Currently reading about the recent history of Africa, since the time of independence for most countries – bleak reading for the most part, but almost obligatory for ex-pats like myself. Plenty of upsetting information, no definite answers, nor a thrilling but successful finale. Looking forward to a good novel next – anyone have any suggestions? [confession – Catherine – I left Leo the African on the plane, before starting it – I thought I’d tell you here, in public, so you couldn’t make a scene].

I cycled out to the local dam/sailing club – great fun, sweaty work for 1 ¾ hours, most of it on dirt roads. Great attention from the local kids. The ego is boosted when the little ones run out to you screaming “Mizungu”, desparate for a wave or a “Hello”, and delighted when you manage to comply. One is a little saddened by the circumstances that lead the older ones to shout out to you “Give me Money”, with their hand out, their only English phrase.

My bike made noises similar to a sailing marina in a gale force wind for most of the trip – not sure were it is coming from, but possibly the front derailer (a word I am proud of, having learned it this year). The back gears slip making gears 1, 2, and 3 unusable – but this only developed for the last 10 km. I had been advised to buy Indian-made, not Chinese-made, but this was the only green one (half truth). All in all, not too bad, though.

Kayaking the reservoir/lake was exciting – I went right to the edge of the dam, where there is no wall, and concrete encasing holds the water in place – flush with the lake surface, like an infinity pool. A 60-ft drop on the other side is enough to keep one alert, and the views are superb.

Followed by sailing, barbequed burgers, cold beer, and a contented lift home.

Work is good, except that we are in a bit of a lull from a study viewpoint. We are desperately trying to enrol patients, but exclusion criteria keep arising. Never fear, when the rain comes, it will pour (metaphorically). In an attempt to boost referrals to our hospital, I have started “The Roadshow”, where I visit all the regional clinics, giving a powerpoint presentation about cryptococcal meningitis, and specifically about our study. It is interesting to see the running of these smaller clinics run, which are mostly funded by NGO or foreign money. They are found in the surrounding areas to the main city – some on the outskirts, some in separate villages, most on dirt roads. I got completely lost on my first visit to one in Lilongwe and pulled in to ask a well dressed guy the way. I was very impressed when he told me that he couldn’t explain it well, but would jump in the car with me, seeing as he had nowhere to be that day, being unemployed. It was great – I wouldn’t have found it without him (and yes, I offered him some monetary recompense, which he initially refused, and then gratefully accepted).

We are kept busy with non-study patients, and admin stuff still sits ominously in the corner. We informally look after most of the cryptococcal meningitis patients. We are getting great experience using Ampho B recently with a whole whack of relapses needing treatment (and one very sad case, a pregnant lady, who eventually died after 3 weeks care). I am getting good experience with this and with placing central lines – valuable lessons.

Seeing some textbook cases too – I had pure pus dripping out of the spinal needle the other day (usually CSF looks like crystalline mineral water). Management is pretty good, with most necessary antibiotics available to us, although ICU beds are almost impossible to get for medical (non-surgical) patients.

We have acquired chickens at home. John, a surgeon who is living with us, has bought some and has gone from novice to somewhat expert on breeding them, medicating them, quarantining them, and unfortunately having to slaughter a few. One of our guards/handymen is very knows the business and gives pointers. Apparently an unfortunate occurrence was when John tried to put one dying chicken out of its misery, western style (humanely, by wringing the neck). However just as he was half-way through the throttling Bright, the guard, screamed out in protest – it wasn’t the Hallal way, and so the startled bird was brought back from the brink while Bright went off to find a knife. Poor chook! I have refused to eat any of the chickens killed due to disease, but had a great tasting one for dinner the other day – reminiscent of the BK mountains 1998 – still a bit stringy and gamey, though, Matt.

Near future plans – hiking the nearby hills/mountains/rocks (strange looking and hard to define), another trip to the real lake, visiting Blantyre, which is the Cork of Malawi as far as I can tell (real capital, and all that …).

Best wishes, and keep well. Feel free to drop me a line – always nice to get a message!

Arthur