On becoming independently mobile

Well folks – try as I might, I can’t keep putting off this next bulletin. Here goes.

A lot has happened, but the rush to tell everyone has worn off: no longer does the sight of a bicycle on the back of a bicycle strike me as odd; no more do women carrying half their bodyweight on their head get a second glance; nor does the sweet refreshing nectar of Carlsberg Green bring a tear to the eye these days. Now don’t think for a minute that I am getting jaded or sick of it, but I can now confirm a sense of having become a more hardened local, with the necessary accompanying steeliness – some might describe an “Indiana Jones meets Laurence of Arabia meets Gorrillas in the Mist” character (meets Morgan Leafy, of course).

The biggest step has been getting my own car – a faded beauty you might say. I looked at a number of potential vehicles but settled on the absolute bargain basement. It had a cracked windscreen, faulty (uncloseable) driver’s window, dented door, faulty lock, faulty boot (unopenable), dodgy seatbelt (but functional), leaky differential switch, and countless miles done (faulty odometer) – did I mention it was a bargain (relatively)? All this lends it a certain “cool”, you’ll surely agree – as does the 4x4 nature and its almost 19 years of experience to impart to me – what a team we’ll make! Oh, to those of you interested in details it is a Suzuki Vitara (dark blue).

I have had no problems to date, and have really put it to the test on a few dirt roads – 4x4 is a must at times and we haven’t even reached the rainy season yet.

My first anecdote relates to driving and work. Our study is going well, but had been languishing a bit recently with a drop in the frequency of enrolments (a recent flurry of activity has us almost back on track (like the stock market? – or should I not mention the big elephant in the corner)). I heard from the lab that a sample of spinal fluid had flagged positive later than usual. I raced to the bedside, excited, in an attempt to find the patient and start the process of engaging her in our care. No patient! No notes, no contact information. Word was that she had been transferred, not unreasonably, to the TB hospital (TB is the next most likely diagnosis without the vital chunk of information to which I was privy).

So I grabbed our study nurse, Julita and zoomed off in a flurry to the dreaded TB wards. This was a complete disaster as no one had heard of her bar one sick patient who vaguely remembered a young one who had passed through quickly and had been discharged early. No relevant records/notes were to be found and strangely there was no nursing staff.

The TB wards are 2 adjacent bungalow buildings (male and female areas) with 2 rooms in each. One room for the more infectious “smear positive” patients, and the next room for the less infectious “smear negative” patients. Overcrowding was obvious with about 10 patients per (small) room and the 2 wards sharing an atrium, with no doors or windows. A gentle breeze ensures a homogenous mixed airflow for everyone (i.e. giving the same (high) risk of transmission for everyone). Almost all of these patients are HIV positive, but despite this there was a great sense of buzz to the ward. They seemed to have been left to fend for themselves for the night but most seemed to be “walking wounded” and, dare I say, in good form.

The sun was setting. In Malawi this means that any hope of accomplishing anything requiring organisation has evaporated. So I took note of a few faces and aimed to return the next morning in an attempt to trace our patient. Just before 8am the following day I arrived to find a team of nurses who denied any knowledge of my patients, backing up their claims by the gaping lack of records. I argued, they argued, I argued some more. We then checked out the outpatients TB set-up – no record of her either. I then grabbed a young Malawian student/intern who spoke good English and told him that he would be helping me for the foreseeable future. We went back and interviewed the ward again, to hear the same story of a transient admission to the ward. Very confusing/frustrating until one nurse informed us casually that she had “decided not to admit her but just to give her a bed for the night” until the outpatient clinic in the morning.

We interviewed one of the TB meningitis patients who had been in hospital for 2 months and found out that she actually knew the mother of the patient, but not the patient herself. A clue, at last.

I will preface the next session with the fact that this delightful middle-aged rustic TB meningitis patient, Teresa, was quite gutsy and sprightly for her 58 years (very old in this neck of the woods), and was obviously very bored of being in hospital for so long. When she suggested that she could deliver us to the mother, I could only wholeheartedly agree. So I piled her into the back of the car, my new “employee” (I’ve no idea what his real job was there, but he didn’t appear busy) into the passenger seat, and we blazed off into the dusty distance (3 heads bouncing in time to the tunes of Johnny Cash on the radio – ah how music crosses cultures!).

We headed away to a “suburb” of Lilongwe. Most suburbs, if any distance off the beaten track of the diplomats and NGO expats, would qualify as bona fide African villages. This was one of them, with bustling markets, dirt tracks, crowds of people, all around 5 miles from LLW itself. 4 wheel drive was a welcome addition with huge potholes to contend with. A white fella like myself and a 4x4 car were pretty pass-remark-able to all around, especially, as mentioned before, anyone under 10 years old. “Mizungu, Azungu” was chanted as my “stealth mission” was being blown.

Teresa disappeared off down a back alley with a vague hunch that the house was around there somewhere. She reappeared 15 minutes later, just as I am drafting my defence/resignation speech to the Ethics committee/College of Physicians for the kidnapping of patients with CNS infections, telling me that the patient’s mother would be joining us for the next leg of the trip. Cue more Johnny Cash and a conversation about the merits of country and western versus religious music.

20 minutes later we found ourselves in another suburb on the opposite side of town (ironically within a couple of miles of our hospital). Pulling up outside a brick house we spotted a comfortable, relaxed lady leaning against the wall enjoying the sun. I was glad of a translator to explain to her that she wasn’t quite as healthy as she had thought, or had been told, and a-la-Arnold Schwarzenegger that she had better “come with me if you want to live” (not quite that bluntly, but you get my drift).

Great way to spend a morning for me, Teresa, and the young fella (I never did really find out who he was). You’ll be glad to know the patient is doing quite well now.

Only one story of many. But time does not permit me to continue. A proper update to follow.

Arthur