Day 25-26 Last Day working in Lilongwe and Bimphi Rural Clinic

My last day working in Lilongwe was spent teaching CPR in the morning to nursing students. Which is pretty funny when you try to show American videos which include "call for help and get an AED". AED's don't exist here, and an EMS service doesn't either!!



Lucky one of the clinical officers, trying out
some chest compressions. No one really
wanted to assess A or B first lol!



Teaching CPR at Daeyang Luke

Day 25 afternoon was spent at Partners in Hope. A non-profit clinic and hospital started and run by Dr. Jansen for HIV/AIDS patients. There is a cryptococcal research project being conducted on the premise, in addition to several HIV surveillance projects.


On the evening of Day 25 (A Friday), we decided to hit the town! Dinner at Latitude 13, followed by a Christmas Cantata.



Dinner at Latitude 13, probably the nicest
place you can eat in Lilongwe! With Donna
and Roberta



Food amazing!!! Cost us a whole 15 dollars a plate, which is
insanely expensive for here! With Laci



Christmas Cantata post dinner! With Jolynn
who sang!



One of the neighbor's cooks drops by to
have his son tested for malaria!

Day 26- Last day working in Africa! Bimphi rural clinic! Located approximately 1.5 hours drive north of Lilongwe. The mobile clinic was set up by Sam of E3. We saw approximately 450 patients between 2 US EM physicians and 2 Clinical officers. Most of the complaints were general body aches, stomachaches, and cough. This is not that shocking when you work all day in a field, while carrying a baby (for the women!), sit around a fire all the time, and only eat carbohydrates. There was a lot of time spent with education to say the least. Each clinic you see a few zebras (no not the African ones, the medical ones) who throw you for a loop, and make you go home and try to re-hash STEP 1 material. It was an amazing last day to end an amazing trip! I can't wait to come back for the next adventure!


Last day working! Rural clinic in Bimphi!



Scenery on the way to Bimphi!



The shops of Bimphi!



Our Bimphi Team!



Setting up for Clinic! Maula brings her 2 month old for her first
clinic with her parents!

The patients line up to be seen in Bimphi!
 



A young Bimphi female!



A classroom in Bimphi



Three young children wait to be seen
in the clinic. Some are orphaned, and may
not have a parent to accompany them. Makes
it a bit hard to hand out Tylenol!!









Jolynn helps me to translate at my clinic
station!



A boy in Bimphi to greet us!



Rapid Malaria testing for basically any
young child with fever! Tis the Season!



My patient looks like he wants to bail!



Dr.Ivey examines a Bimphi patient

These three young girls showed up alone,
complaining of headache!

I hope the bridge holds up!
 



Goodbye Bimphi! Sad you leave you Africa!
 




















 

 

 

 

 

 

 

 

 

Day 21-24 Back at Daeyang Luke

The last week was spent at Daeyang Luke in the Casualty department.

 

The interesting cases of the week included a chronic traumatic knee

effusion, drained of course with a catheter. A older woman with a ulcerated left breast came in after 5

years! Previously diagnosed as eczema with a biopsy that was negative for Pagets, but likely very superficial. We had a post-op patient fistulotomy patient with an ileus vs. volvulus. The surgeon was quick to want to go to the OR but luckily was convinced to try to scope the patient first. On the ward the patient made a full recovery, but as per his wife was dying of hunger. The Malawians can't even go two days without their nsima!

 

Typical Solution at Daeyang, drain it with a catheter

 

Chronic traumatic knee effusion

Ileus vs. Volvulus? Post fistulotomy

Sadly we had one child this week with suspected cerebral malaria. She had be diagnosed the previous day with malaria, started on LA, but continued to have fever, and became progressively more altered. She responded only to pain on exam, and had periodic episodes where she would shake her arms and legs. It wasn't a typical seizure, and even after her fever came down, she continued to have periodic episodes of shaking, mainly with tactile stimulation. it was quite a feat to find some rectal Tylenol as it is not routinely given! I couldn't find an answer to whether PO could be used in the rectum on google! She was started on Quinine, and then treatment for suspected meningitis infection. Many children with cerebral have a very poor outcome, and live with long term seizure disorders, as well as physical and mental incapacities.  



Transferring a pediatric trauma patient,
Malawian ambulance driving is quite an
experience!



Writing admission orders, hard at work!

The other pediatric case of the week which was very disheartening was an auto vs. ped. The young boy was hearding cattle when he tried to get his cows across a street and was struck at 50kph. He had a GCS of 8 on  arrival and a large laceration on his forehead. He was taken to the CT scanner, and was not found to have a bleed, by our radiology scan. The boy was stable to be transferred to KCH, the community hospital which does have a neurosurgeon on staff. Granted, this hospital is frequently out of medications, anesthesia drugs, and even water!! The ambulance drive was a bit scary, I was hoping not to become a trauma patient myself!! 

The COGRATULATE cake! For Sister
Beak (Mission Director of Daeyang Luke)
 who earned the Florence Nightengale
award.

Thursday afternoon, was spent helping to run a seizure clinic.
Many of the children had been afflicted by malaria, meningitis, or complications during birth, and are now suffering from the sequelae. Trying to come up with combinations of carbamazepine, phenytoin, and phenobarb is definitely beyond my scope! I am not envious of neurologists!!





 

Day 19 Prision clinic and Crisis Nursery

Day 19 was spent at the Maula Prision in Lilongwe. There are 60 women housed in the prison and approximately 2,300 men. This is a minimum security prison, so many of the prisoners are in for fighting, theft, and even wondering the streets at night. The justice system in Malawi isn't the best so many people spend several years incarcerated for false allegations. Some of their paperwork may be lost during their time and they may never even know why the person was incarcerated in the first place. The women's quarters are much better than the men's as the population is much less. The women can keep one child up to 5 years of age in prison with them. We saw approximately 10 babies during our clinic all very well appearing. The men sleep several hundred to a cell, which means they are basically all spooning on the floor together each night. Skin diseases are rampant among the prisoners, scabies being the worst. Those affected by HIV have a hard time keeping up with their ARTs as the clinic frequently runs out of their medications. This inmates don't last very long. Death due to disease is very common in prison. Unfortunately no pictures in the prison!

Our team at Maula Prision, Charles who was a previous inmate, now runs a ministry in the prsion. Our translators
are students at the African Bible Clinic. And Laci and Selina were are pharmacists. We had one guard!

Our afternoon was spent at the Crisis Nursery in Lilongwe. This nursery houses and feeds children from the ages of birth to two years old. All of their mothers have passed away either due to HIV/AIDS or due to complications in labor. You can visit the babies every day from 2-4pm. The have 12 babies at this time. Some of the children will go back to the extended families once they are able to eat table food at 2 years old, and some are adoptable.


One of the Aunties preparing porridge for the children.



One of the babies with hydrocehpalus



Laci with twins and another baby.

I may steal this one!



Day 14-16 Pothawira Clinic



Peter and Emma Maseko the lovely
family I stayed with who run the Pothawira
orphanage and clinic

Days 14-16 were spent working in the Pothawira clinic in Salima, Malawi. Several hundred people would come per day some traveling great distances to receive medical attention. The district hospital in Salima is frequently out of medications and many patients look to outside private clinics to get help.









My clinic room




My consultation room



Henry the clinical officer helping me
with translation and standard
Malawian treatment regimens



an infected leg wound on a young
girl



One of my not so happy patients in the clinic
 




A young patient with chicken pox



Snake bite one week old, pretty sure that's
a tendon hanging out of the larger wound!



Peter and some of the locals in the clinic
who have donated rice to the ophans





Impetigo, incredibly common among the
village children



Ultrasound machine at the clinic
which unfortunately cannot be used
as it does not have a voltage converter
as it costs 40,000 USD





















JC was brought to the hospital
after his mother died enroute while
delivering the him. This is very common
and is one of many reasons there are
many orphans in Malawi.
His extended family did not have the means
to pay for formula to feed him.





Some of the largest abscesses I have ever seen
this boy was 2 and had a large abscess behind his ear
 







 









Several of the orphans from Pothawira

A trip to Salima District Hospital, proved to be quite dismal. There are several patients crowded together, there are approximately 400 deliveries per month so women cannot stay more than 24 hours post deliver. For C-section deliveries they can stay up to 4 days. The pediatric ward this time of the year is on the brink of becoming overcrowded as the malaria season starts. The pediatric ICU differs from the pediatric ward since it houses an oxygen tank for the children.

Pediatric death statistics



The number of obstetrical deaths per year

 

Causes of maternal deaths

Following the clinic we took a trip to Livingstonia for a trip to beautiful Lake Malawi!





The scene from lake Malawi

Monkeys by the pool

the local brew



The pool at Livingstonia, much needed
its summer here!

Lunch at Livingstonia an oasis in Salima




A young girl sells peanuts at the market

Some locals at the beach!



 

The crocodile farm in Salima. The crocodiles are raised to 5 years old
then sold for 8USD per square on their tail.



A real American Thanksgiving
in Malawi, without power of course!
 



Thanksgiving with Turkey!!