On a Fair, Sick Night

Releasing writer’s block can be a bit like getting wax out of an ear – difficult to successfully accomplish with brief, half-hearted attempts, and really requiring a period of dedicated attention. This can be applied to blog tardiness, or academic work in general. There’s a piece of knowledge (or is it wisdom, B O’D?) for nothing.



All is ticking along here. Time is flying by so fast that I’m surprised that I’m not registering just a series of bright flashes and dark spells to signify the passage of days. I can’t believe it is March already.



Work is going well, but frustratingly the study is awaiting the all clear to get up and running again. It has been on hold since the New Year seeing as our results were decent enough to prompt us to change our protocol to try to address slightly different issues. We are awaiting the approval from the 3 different regulatory bodies involved in our study (Malawian, UK, and US) before we can restart enrolment. [almost there, though].



In the mean time I have been keeping busy with time on the general wards, preparing for the next step, and working on our results to date. It has been educational and enjoyable to have been able to take specific responsibility for one of the wards and keep tabs on exactly what is going on. I am seeing a lot of textbook HIV-related cases and stereotypical issues regarding management in resource-limited settings.

The typical day begins at 8 am with the handover from the intern who had been covering the night before. [Funnily enough, this is perhaps the only meeting in Malawi that I am aware of that starts right on time daily. For most other appointments the well-worn tag of “Africa-Time” is often rolled out]. An account is delivered of all the admissions, discharges and deaths with a more detailed review of the sicker patients. Much of the information presented is taken from a ward handover book of dubious reliability filled in by the nurses. It gives updates on the sickest patients, the admissions and deaths. I am quite taken however with the phrase that completes most entries: “All of the others had a fair sick night!” To me “On a Fair Sick Night” sounds like it would suit as the name of an epic poem about the trials and tribulations of an Irish doctor in Malawi.



Ward rounds, and outpatient care in our clinic room keeps one busy until lunch. After lunch the jobs are a bit more haphazard and less structured, but usually keeping things going for the afternoon. When my crypto study is not running, it is rare to have to stay late.



It highlights to me that what keeps a team really busy in Ireland and similar countries relates to having extra resources: organising a scan does not take time if the scan is not available in the first place, if you get my drift. The same applies to getting specialist reviews of your patients and most paramedical aids. Unfortunately this logic extends to treatment decisions also: with a limited repertoire of medications the choices are less.



It also helps time-keeping to have a smaller physical area in which the patients are cared for than in some of the massive hospitals I have worked in back home. We have 2 public medical wards – 1 male and 1 female with a corridor linking them. They accommodate about 50 patients each, including the overflow patients that are out in the airy Khonde (a covered veranda/porch/balcony area). There is also a private ward upstairs with similar care, but a better nursing ratio, and less crowding.



I am enjoying this hiatus, but also busy preparing for our coming step of the study – implementing new protocols for treatment of our studied meningitis. It is good to have this period to iron out any teething problems before the regulations of a study.



Socially things have been good too.



The rainy season is petering out. Less frequent rains, lighter showers. We even had a false alarm recently where it seemed as if it was over. There were quite a few worried looking Malawians, concerned that the crops hadn’t matured enough and that it wasn’t time for harvest. Thankfully it has picked up since.



The rains have changed Malawi hugely. What used to be a backdrop of scrub vegetation and predominantly red dirt is now a lush and verdant countryside. Where you used to see dry ditches and dead grass is now 8-foot tall maize and vines. The difference is astounding.



It was especially notable a few weekends ago when 6 of us took a weekend off to go to Liwonde National Park for a brief safari. I hadn’t been sure what to expect from the trip. One of the few things I knew about the park is that there are no lions or big cats, and to me it seemed that these animals are synonymous with safari. Perhaps a “safari” without cats is just a drive in the fields? How wrong I was!



Apparently going in the dry season leads to more big animal sightings because of the necessity for them to frequent the same watering holes. Regardless of this, we got see our fill of hippos, crocodiles, elephants, a variety of deer-like creatures and warthogs (with their glam rock hairstyles). We even got to see a big family of elephants and some night mongooses (?mongeese?). There were also myriad interesting birds such as eagles, kingfishers, falcons, and grouse (no choughs, though).



It was an amazing experience to be trundling around in our big safari vehicles without the animals being unduly scared – I presume we represented a single, clumsy looking, rather innocuous beast as opposed to a group of ignorant bipedal predators. You would think an engine would be startling to the animals, but no – it was just our noise, like a funny barking or braying. This meant we got to drive very close to many of the animals – closer than the people who decided to go on the walking safari, who obviously were seen as more of an intrusion by the wildlife.



I confess that was thankful for the lenses of my binoculars and video camera. Despite feeling a bit like the stereotypical [*insert your least favourite nationality here] tourist who videos the cathedrals and cities without looking at it with his eyes and experiencing it, I was absolutely converted to the benefits of digital technology – who am I kidding? - I have always been on technology’s side. Anyway – I had fun videoing things and stitching the highlights together on the computer – perhaps to be inflicted on the less fortunate of you.



On an unrelated topic – the rugby is super, isn’t it? A few of us have been getting together to watch the Irish games and can’t believe how well things have gone for us to date. In any case we are in for an exciting finale, I’m sure we all agree.



Just finished The Poisonwood Bible – phenomenal book, set in the Congo from the 1960s. I fully recommend it to seasoned African travelers and armchair explorers alike – in fact anyone who likes good quality writing.



That, I’m afraid is my brief update on things – strictly PG rated, if even. I can already almost hear one tall blond Galwegian cardiologist’s condescending comment of: “Very nice … any more short boring stories?” For any details on the more salacious or scandalous events that may be going on in the Lilongwe social scene, I’ll await specific enquiries – although the old adage of “Ask no questions, hear no lies!” may well ring true.