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Two new posts

Two new posts tonight, and there are still a few to come!

March 2 – The Long Way to Lilongwe (sorry…)
March 6 – Socks so soft in London

I note that Internet Explorer doesn’t display my blog pages correctly. Sorry about that – I’ve been using Opera, which is a far better browser. There should be a column on the right hand side of the page with all sorts of useful search options and gadgets in it, but instead Explorer puts it at the end of the page, underneath the blog entries. I’ll try fix it. [Update 18 March: Problem fixed.] Also, the links to other Malawi blogs in the post of Feb 28 have now been fixed I think.


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Socks so soft in London

I stepped off the aeroplane at 5h45 at Heathrow yesterday morning, smack into a bracing cold breeze, unexpectedly refreshing and pleasant after months of sweaty heat. Later though, after walking outside in London for a few minutes, covered in layers of shirts and fleece and jacket, I soon longed for some warmth again and the freedom of a simple T-shirt. I got caught in the early commuter traffic on the Tube, everybody wrapped up similarly in coats and books and iPods and individual purpose. At the same time in Zomba, in another world which seems quite unreal now, people were sauntering and cycling along unhurriedly under the trees, stopping, greeting, smiling and shaking hands, yelling across streets and markets at each other, wheeling and dealing, with the sun was shining warmly on their backs. After a mere six months in Malawi, I want to wave or nod or raise eyebrows at most people who I pass, acknowledging their existence and communicating that everything’s just fine, “chabwino”. That doesn’t really work in London, nor I expect in most of the UK. P1040776 Over the man next to me’s shoulder I read a headline in the Metro which momentarily held his attention, “Rare African meningitis kills mother in six hours”. Africa gets such bad press! It’s not that the reporting is untrue – there are many nasty bugs and problems in Africa – but it is so one-sided and sensational. This headline serves only to confirm the exotic fantasy of a savage and unforgiving continent. I fancied the man gave a knowing sigh and cynical shake of the head as he turned the page to read about the latest M&S Meal Deal. Read the rest of this entry »

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The long way to Lilongwe

This morning I woke early wondering what it will be like to find myself back in “the civilised world” in three days’ time. I imagined waking to a cold grey London morning, full of bustle outside, dense with everyday purposeful activity, but with far fewer smiles than I have become accustomed to in Malawi. And I felt a little bit of panic, to be honest. Panic not simply about finding myself in a literally and figuratively colder part of the world, but also panic about losing my own sense of purpose, not knowing where to fit in, of being superfluous and unimportant. Even though in Malawi we have complained and argued about, and often doubted, the effectiveness of our work, and of “Aid” in general, I don’t think many of us have regularly woken without a sense of being somehow needed and valued. This sense of purpose may be misplaced, perhaps artificially maintained by our status as mzungus, our sense of “knowing what should be done”, being part of a larger organisation like VSO, or a vague notion that we’re “helping”, somehow. At some level we can always fancy we have a “mission”! This sense of being needed is of course frequently bruised, usually when our Malawian workmates and employers seem to ignore, forget, resist or undermine what we suggest, and then we become frustrated and fed-up. This is not uncommon. It is then that we turn to our other important source of feeling part of something and of having a place, when we complain and rant with our friends and fellow volunteers after work. Our social networks here, formed early on but always flexible and welcoming, are powerful sources of support and identity in this odd situation. Volunteers are an interesting and varied bunch, from diverse backgrounds, people who we would probably never have gotten to know under ordinary circumstances. But arriving in a strange place with no family or friend support nearby, with a new culture, language and challenges to face, is hardly a normal circumstance. Superficial differences between volunteers are overshadowed by our common predicament and goals. So we end up supporting each other in an unusually open and inclusive way, knowing that we rely on and need one another. Friendship and trust are assumed, and freely given. (A similar though perhaps less intense environment forms when a group of international students arrive together in a new city, as happened when I was in Edinburgh in 2004.) On the flip side, tensions can also escalate in this pressure-cooked environment, with resulting flare-ups and fallouts. Volunteers are all slightly odd individuals perhaps, and David (fellow VSO volunteer in Dedza) and I were wondering this evening whether we’re all either escaping from something, or just weird, as has been rumoured. That’s probably a but cynical, but probably not completely off the mark. (I of course am an exception, neither escaping nor weird.) [Update: 24 March – Returning to Edinburgh for a visit now, reflecting on the life  and issues I left behind, I’m no longer so sure I wasn’t escaping.]

P1040657 Noel’s brilliant
scrabble board, Jess
and I playing along.

This sense of being a team has become more apparent as I say my goodbyes. Read the rest of this entry »

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To blog or not to blog?

Writing this blog has been fun and rewarding. Organising my impressions, thoughts and reactions into words, sentences and paragraphs has been good mental discipline, and I’ve written as much for my own record as to entertain others. Writing a blog also encourages one to observe more carefully, to make mental notes as one goes along, and to identify the humour or pathos in a situation, and this is a good habit I reckon. I’ve often reflected that one doesn’t need to embellish or confabulate stories here in Malawi – just describe it as it is, and it’s probably interesting or funny, maybe even poignant. Although any daily life contains much that is interesting or funny or moving (which is what makes psychiatry worth doing), I’m not sure that returning to “normal life” will offer up as much to write about so easily. That requires a more skilled observer and writer. So I may write a little bit about settling back to life in Cape Town, as it relates to my experience here, but I’ll probably leave it at that. I suspect though that I will be adding some final Malawi entries for the next month or so, so do come back and check! I’m really pleased that people have enjoyed reading this so far.

For more Malawi blogs by my friends and other volunteers here, check out those below. The links are also posted in the column on the right.

Noelpatrol – Yes it’s Noel my housemate, a volunteer with AVI (Australian Volunteers International). His blog has some great photos.
Hales in Africa – Ilona Hale is the energetic Canadian VSO doctor I’ve stayed with in Ntcheu.
From Malawi with Love – Maureen is an Australian volunteer who’s stayed over at Noel’s house a few times. She was working at Mua Cultural Centre until recently.
Malawi 2008 – Fellow VSO volunteers who came out in my group, Mike and Penny are living and working on the Satemwa Tea Estate in Thyolo in the south.

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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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Guest entry: Colin Dewar

Colin Dewar is a consultant psychiatrist and friend from Falkirk in Scotland, who came to visit recently for ten days. I asked him if he wanted to contribute to my blog, and I’m delighted to say that he agreed! A new person’s eyes and observations are always interesting and welcome.

When people say that Malawi is a beautiful country they don’t say whether for mountains, lakes or plains, even though it has all of these. My first impression was of greenness, much of it from maize that surges from the ground during the rainy season. There are a few trees left after deforestation, wherever the land is not cultivated, as on a few rocky hillocks where goats graze. P1040472

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Preparing for goodbyes

My time in Malawi is rapidly running out, with only four working days left! I can hardly believe it, and although time has flown, it also feels like I’ve been here a while as there has been so much happening, especially latterly. There is so much I would like to write about but probably never will, and even tonight the posts I’m putting up are a bit backdated… But I do hope that what I’ve written has given a bit of a flavour of what it’s been like to live and work here in Malawi.

New posts tonight:

1 November – ICT 2: We’re not alone
7 November – Motorbike Training
8 November – Are we doing anything useful here?
27 November – Sometimes I wish I could just stand and watch

February began with the arrival of Colin Dewar, a psychiatrist colleague and friend from Falkirk in Scotland, who came to see how psychiatry was done in Malawi. Colin stayed for just over a week and fitted into our busy house very well. His trip of ten days was short indeed, limited by the practical constraints of a fulltime NHS job, but we managed to pack a lot in!

The first weekend of Feb I visited Lake Malawi again, with the group of Scottish psychiatrists sent by SMMHEP to help with the annual teaching of psychiatry to medical students. All five psychiatric visitors are staying with Rob in Blantyre, his house now having become a bit of a commune. We all drove up to Cape Maclear (where I was for Christmas, almost) and shared a single large dorm room. Eight psychiatrists in a single dorm room works surprisingly well, but maybe only because they’re a fairly good-natured bunch. The Gecko Lounge at Cape Maclear was once again wonderfully relaxing, and Colin joined us on the first night straight off the airplane from freezing Scotland. I completed my PADI Open Water course, and Colin went snorkelling next to the island. Colin is a keeper of tropical fish back home in Scotland, so snorkelling amongst the brightly coloured (and expensive for collectors) Malawian cichlids was especially rewarding for him. His excitement was infectious and rewarding for me too.

P1040250_1Back at Zomba Mental Hospital, Colin joined me in ward rounds, and I found it very useful and instructive to have a fresh person’s view of what goes on. I am so often bewildered by the psychiatric presentations of patients in the hospital, and they appear so different from what I was used to in Scotland. So Colin’s comments and experienced ear were “most welcome”, as the Malawians say. I just wish he had visited earlier! Colin also took on a daily special task of tutoring the new Clinical Officers who have recently started working at the hospital. They are officially permanent staff, and they are “clinicians”, sorely needed and only just in time. I leave in a few days, and then my role will have to be taken by one of the new Clinical Officers. They do five weeks of psychiatry in their third (final) year, and that’s all. They are very keen but without any post-graduate psychiatric training. Our overlap at the hospital will be almost foP1040347-P1040348_1ur weeks – so very short! So I’ve been trying to focus my teaching efforts on any of the new CO’s I could find over the past three weeks, but haven’t had time for extra formal tutorials. Enter Colin (photo left)! He met with them (and sundry nursing and other students who wander in) every day, discussing psychiatric history taking, mental state examination and other basics. This is very valuable input, and gratifying for Colin as well I think.

P1040331_1   Colin dared to ride
  on the back of my
  bike to work some

  That’s our house in
  the background on
  the right.

P1040273_1 This is my favourite old lady in the market. She always has an energetic smile (except when photographed, apparently), and she takes delight in speaking Chichewa slowly to me. We have the same banter every time, and I usually buy her beans or ochra.

The final weekend we went up Mulanje, staying over in Chambe Hut on the plateau on Saturday evening. It was a big party – 15 in all I think – including the SMMHEP psychiatrists and Rob; Annie, Becca and Caroline (ABC – the English med students); Chris and Sameen (two new friends in Zomba); Noel and Denise (who is the third housemate now – moved in two weeks ago). The group worked very well, and I’ll put some photos up in the next day or two… I hope!

   The Mulanje crowd at Chambe Hut.

Then on the Monday we had to say a sad goodbye to ABC, who’ve really livened our lives up here in Zomba over the past weeks. Noel and I will miss them, but I look forward to visiting them in London in March briefly. Tuesday morning saw Colin leaving early to catch a flight in Lilongwe later the same day. His was a brief but fairly intense visit, and I’ve enjoyed our discussions about natural history and psychiatry.

Which brings us up to last week. I’m sure there was some sort of party or dinner, but I can’t remember exactly which one now. I write this now, snatching a much-needed quiet evening to update my blog and catch up on some admin. I returned this morning from a little psychiatric outreach trip to Ntcheu District Hospital (invited by Ilona, a VSO doctor) and Bottom Hospital in Lilongwe (suggested by Felix at Zomba Mental), both trips doing some teaching and clinical work. I’d like to write about this trip, and it’s frustrations and modest successes, but I’ll leave it for another time. Now, I need to sleep!

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