Two (Update: five!) new posts

Two [update: five!] new posts, thematically related again, almost coincidentally.

4 December – Brutality
22 January – What can be carried on the back of a bicycle?
10 February 2009 – The Greening
16 February – Minibus capers in Lilongwe
20 February 2009 – Guest blog post: Colin Dewar

More to come in the next few days, as I go on a week-long tour of southern Malawi on my motorbike, visiting Rob and other VSO’ers for the last time before flying to the UK on 4th March. Tomorrow is my last day of work, but more another time.

[ Update 26 Feb: After some motorbike problems which set me back a day, I leave for Blantyre in an hour or so. My bike was cutting out at random in town (including with Noel on the back, twice, embarrassingly) and I felt it would not be wise to risk a longer trip until it was fixed. Our neighbour here is a mechanic who has lived and worked in the UK, and he kindly took a look at the bike, and suggested that the fuel tap was open too much, thus flooding the carburettor. So we closed the tap a little, and the bike is purring along beautifully now. I took a spin up the plateau road to test it, and for a last look over the green plains around Zomba. It’s a pretty town, and small enough to start to know well even in six months, and I’ll be sad to leave it. Our house is almost opposite “Tasty Bites”, the most popular little cafe where most of the expats and volunteers turn up randomly for lunch or coffee. We can see who’s there from our gate. Walking into town, it is almost unusual not to meet someone and stop for a wee chat and confirm the next get-together. In the past two weeks, I’ve had the unsettling experience of hearing about dinners, parties and trips planned which no longer include me because I’ll be gone. Denise, who is living in Noel’s house as well, jokes that these enticing plans were one of the reasons she stayed on longer in Zomba after her VSO placement finished. But I must go. the experience here has been intense and challenging, chock-full of life and energy, and I am starting to feel a bit drained. Work has taught me enormously, about psychopathology, education, culture and how they interact; about how to work with and manage chaos; about how to continue even when they way isn’t clear; and about how to be patient (well, sometimes).

I do have concerns about my ward and the hospital, echoed by the two excellent nurses I mostly worked with. Sister Chimwemwe complained that there was no farewell party for me at the hospital, then she added sadly “but we have nothing to celebrate when you leave.” I apologised, “Pepani.” I’ve tried to prepare the nursing staff and new clinical officers for when I’m not there, but time has been short. In that sense I have been “gap-filling”, a taboo word in development circles as it suggests that you’re merely doing a job and not transferring skills. VSO is all about transferring skills and being “sustainable”. But I have argued that one absolutely needs to “do the job” in order to understand some of the real issues, and only with this understanding can one try to make a “sustainable” difference. So I’ve “done the job” – seen the patients – and it’s my hope that the nurses, CO’s and students who sat in with me have learnt something. I also tried to do a lot of teaching and explaining whenever possible. They say they’ve learnt a lot. In preparing to leave, I’ve slowly withdrawn from seeing many patients, and from running the ward rounds when I’m there. I’ve asked a nurse of clinical officer to do the interviewing themselves, with comments and guidance from me. This has partly worked, but I wish I had more time to spend with them. I felt an insidious desperateness creeping up on me as my last work day approached, and I think this may have been shared by the staff. But they are very stoical, and have not shown this explicitly. There may be a new VSO psychiatrist coming in June, and I hope to give a copy of my report and even discuss some ideas and challenges with them, so that they can get a bit of a head start. There are some things I would suggest to do differently, and some projects I’d try to implement which we’ve not done this time. New wards are being built, and more staff are slowly being attracted. The BSc in Mental Health program up at St John of God’s in Mzuzu (in the north) is exciting, as it allows CO’s to earn a degree on top of their Diploma. This is attractive for them, as it means more money and higher positions, and it is giving mental health some status. Already we’ve seen the first crop of these BSc students at the hospital (I’ve written about them here and elsewhere) and they are sure to contribute enormously after they graduate. I hope to visit again in a few years to see how things are coming along. ]

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