On raining, cats, and dogs

Apologies for the delay in updating this. Here's a start:

We are entering the rainy season here (less ominous sounding than the Scandinavian “Dark Period”) and the old adage of “When it rains, it pours”, rings true. We have been treated to a well-received drop in max temperatures (almost unbearable 3 weeks ago), blustery conditions, and occasional spectacular electrical storms. When it rains, it is liable to dump buckets on you - this coincided nicely with our football game the other night where we got as wet as can be above sea level.

Another interesting side of it all is the increase in general activity one sees around the place with every able bodied person trying their hand at part-time farming. Areas that previously appeared to be wasteland now seem decidedly arable and are planted all around the city. People are fixated on maize, the staple, despite appeals from certain food agencies to get people to switch to a more efficient and economic crop. Maize is used to make nsima the Malawian equivalent of Mashed potato/stodge, but apparently it is a very time- and resource-consuming process. Nsima is to Malawi what potatoes are to Ireland.

To call it the “rainy season” may not stand up to analysis by Irish natives. Even in this time, it does not rain every day, and the sun is often out and very hot. “Unfair” I hear you mutter, as it sounds more appealing than the June – June rainy season of home (without the hot sun).

Work is going well. We are [nearly] up around our expected targets for the study and general ward medical work is amassing. Since the change in weather there has been an increase in admissions – mainly due to an increase in gastroenteritis and malaria. We expect to see an increase in our cryptococcal meningitis pick-ups too, just due to the sheer increase in numbers of patients admitted – we actively go looking for cases with symptoms suggestive, even if the admission diagnosis is considered as alternative (occasionally the working diagnosis is “surprising” to say the least).

We are about to do an interim analysis if the results to date and if there are highly significant findings we may be in a position to adapt the study further.

I did a peripheral hospital visit with the medical department to Dedza, a rural town about an hour from us. It is a weekly visit by a couple of senior staff from the medical department to a district hospital. They have a rota of sites to visit, so each institution receives us about once every 2 or 3 months. These places often have one or 2 doctors, at quite a junior level, minimal investigations, minimal therapeutics, poor decision-making, and a few clinical officers (a grade we don’t have in Ireland – not quite a doctor, but almost (it is a shorter degree course)). It was a clinican’s playground with unbelievable pathology on display. It felt like membership exams again, with a quick round of the sickest patients and an impression/analysis and management plan. We saw all manner of cases in a whirlwind morning, and arranged for transfer of one or 2 of them to our facility. It really was full-on African district hospital medicine in the extreme. We saw TB, strokes, cardiomyopathies, motor neurone disease (!), metastatic cancers, and a ?subacute combined degeneration of the cord (!!).

Since my last notes I have managed to see a bit more of the country – from the rugged mountains overlooking Zomba, to the steep cliffsides of Nkhata Bay, and various mountains and plains in between. Some of the lakeside areas are truly idyllic.

Driving in Malawi is worryingly very like playing a video game – oftentimes you bounce either side of the midline, take shortcuts cross country, flicking on your car horn like a joystick trigger. “Creative driving” and freedom of expression is encouraged in traffic. I was behind someone in a car park the other day who decided to slow to a halt and then get out and lock-up. I am not one who usually succumbs to road-rage, but was incredulous and incensed seeing as he was right in the middle of the thoroughfare and I was directly behind him, now blocked. He even looked half-heartedly at me and with what would have been an acceptable Gallic shrug pointed back, suggesting that I reverse back out the way we had driven in. Much beeping and shouting through my broken window led to a change in heart – he drove forward 10m into a perfect parking space, freeing up the road again. For anyone familiar with Africa, I’m sure there will be no major surprise [although I will try to refrain any more African-bashing stories, which unfortunately are staple ex-pat anecdotes].

I have had a couple of run-ins with the Gardai Siochana (or the Malawian Branch of it). The first was due to having a faulty brake light, the second for not wearing a seatbelt. Both times I was told I would need to attend court the following morning. Both times I managed to get away scot free, without [really] resorting to bribery, and with a total time expenditure of about 35 minutes of debate. The content of my plea-bargaining was pretty similar, and shameless, both times. I discussed my case, the wonders of Malawi compared to home, and the superiority of their police force. Mentioning HIV patients and ward rounds was not beneath me, and on one of the times I went as far as to suggest that the 2 policemen come for pizza to continue the debate. The downgrade of the punishment both times was to give the guards a lift to another part of town (they have no police cars), with light-hearted banter about the similar problems facing Malawi and Ireland – dodgy politicians, bad roads, poor healthcare administration. Disgraceful behaviour, I know, but anyone I know that has had to go to court on such charges has had unbelievably frustrating inefficient hours whittled away in stifling, crowded heat and mind-boggling infuriating beaurocracy.

I did have an amazing time recently out at the Kamuzu Dam, where we often go to spend a few hours on a Sunday. I was taking out a canoe for general paddling about and wondrous amazement at the dappled early evening sky. I passed a fisherman in a dug-out boat (actually a hollowed out tree-trunk – very wobbly, but they make it look easy) and had a quick intercultural exchange with nods and pleasantries – the extent of my Chichewa language. I then went further across to the other side of the lake, where it looks like undiscovered territory further down. I heard shouts, and calls from my friend in the dug-out and saw him animatedly shouting at me. I though he was either in trouble, or needed help in pulling aboard a big fish. As I went back to him I established that he was suggesting that I go no further to the big hippo that would have been in my direct path! I saw him then, and watched him yawning and grunting at me, while splashing about in the water. Before anyone questions my eyesight, sanity, or judgement, rest assured that the closest that I made it to him was 50 metres. Amazing, though. Of note, hippos kill more people than any other large animals in Africa.

The Lake of the Stars music festival was unbelievably good in October. Imagine a casually dressed Trinity Ball lasting 3 days, at the beach, costing very little in glorious weather. It was something like that. Further stories on request only.

We have had a couple of cats introduced to the household. Kittens, to be precise. I have never really been a cat liker/lover, but must say that I find these guys intriguing. After our puppy died, and we were all saddened, we said that we would try not to get attached to any more animals until they proved that they could survive to adulthood. These guys are great to watch hunting spiders, mice, and fighting each other like boisterous kids. [On that note - we had a kid goat for less than 24 hours – his bleating was horribly shrill and human-like – he was barbequed that evening and was very tasty, perhaps all the more so for having woken us all at 530 am].

Apologies in advance to Catherine for this next couple of paragraph. Anyone with a serious insect aversion skip ahead. The bugs that have emerged since the onset of the rains are really impressive. Centipedes thicker than your finger and 6 inches long, spiders bigger than the palm of your hand, and giant beetles (who seem incredibly poorly equipped to get off their backs – a fact which could be used by either side in the creation/evolution “debate”, I’m sure) to name but a few. Some of the centipedes have far bigger body mass than the little birds you see zooming about.

Last week there was the night of the flying termites – where they all hatched and were absolutely everywhere for one evening. Gross, but amazing to see. The next day there were insect carcasses everywhere, crunching underfoot, the following day all that was left was their wings scattered around, the rest having been scavenged by other insects. People delight in this annual hatching, and even consider it a delicacy to eat. Our guards left the door open with the light on in their work station. A bucket of water was placed underneath and as the hundreds of flying termites fell into the water they were scooped up and stored for later frying (although some were eaten raw/alive – I joke not).

Looking forward to Christmas. I will be home in Cork on the 21st Dec. Between then and the 3rd Jan I plan to be in Cork, Kinsale, Galway, Belfast, and Dublin. I’ll have my phone, so be in touch. Until then – Tioanana!