Medical Blog

We, meaning myself and two talented Malawian dentists, saw 96 patients  in the dental clinic today. 96! And I am confident the next few days the numbers will be even higher and that’s because access to care and dental supplies is so limited here. The government dental clinics have not had any lidocaine for the past three months so they have not been able to perform any extractions. Can you imagine having to wait for months to have a painful, decaying tooth extracted?

With poor access to care, extractions are the most frequent and required treatment option for the villagers and care in these remote villages is done without electricity or running water.  With the commitment of our Malawian partners and with support from my colleagues in the Us we are trying to shift that paradigm. Each year that I have returned to this community we have brought additional materials and equipment to support more treatment options. In 2014 we were only able to provide extractions and we did so with patients sitting in two plastic lawn chairs.

Today we have three Asceptico dental chairs a generator and portable dental hanoieces. This year we added a portable cavitron machine which will allow us the ability to clean teeth and treat periodontal disease. We also brought restorative materials for doing dental fillings meaning we can repair teeth instead of extract them. All of this equipment is used during monthly dental clinics run by VIP. It’s exciting and invigorating to impact such critical needs and to do so in a great partnership with my Malawian dental colleagues. It’s time for bed now though because hundreds will be waiting tomorrow.

I can only describe today as terrifying and honoring. After lunch, one of the providers named Sarah, whom I had formed a close relationship with the day before, came up to me saying we were being called away to see a patient. So, I grabbed a blood pressure cuff, my stethoscope, and a thermometer. We hopped in the back of the land cruiser and we were on our way. Finally, Sarah told me what was going on. The chief’s husband was sick and was unable to walk to our clinic so we were coming to him. As we drove, we went over the correct greeting with Sarah’s translator and when to kneel and when to stand. We arrived and our moment of truth was upon us. Sarah and I looked at each other, gave a terrified excited smile, and went to the chief’s door.

The chief and her husband were extremely kind and welcoming. Sarah asked what his complaints were and to see his medical passport. The chief went off in search of the passport and we continued to get information from the husband. Using our translator Emma, we were able to get all of his major symptoms. We went through the passport looking at his medical history. We really collaborated together about what diagnosis we were thinking and how to best handle them. Knowing that he had a history of hypertension I went in thinking the blood pressure was going to be high. I took it once and got a low reading. I turned to Sarah and told her my findings and said I wanted to take it again. Diving deeper into the history Sarah found he was taking medicine for his hypertension and the reading I got was similar to the ones that they were getting while he was taking his meds. Knowing that my second reading was almost exactly like my first, I moved on to the easy stuff, temperature and pulse. He thanked me and gave me a toothy smile.

Knowing my hard part was done I returned to Sarah’s side to figure out what medicine treatment would best take care of his ailments. We explained to the chief and her husband what our plan of action was and that we would be back in 15 minutes with medicine and instructions. After many thanks were exchanged in both English and Chichewa, we calmly walked back to the land cruiser. Once we were safely behind closed car doors Emma, Sarah and I all let out a huge deep breath and burst in to laughter. As the car drove, we went to work on our med plan. When we reached the clinic, Sarah asked to wait in the car for a few minutes to finalize the plan and celebrate. After a group-hug/high-five situation and some good old women empowerment encouragement, we went into the clinic in search of our meds to bring to the chief.

This experience in Malawi has been incredibly impactful. I am out of my comfort zone completely, eating new things, taking manual blood pressures, standing or rather kneeling in front of village chiefs. I am so thankful to my nursing instructor Lucy who encouraged me to go on this trip on Thursday morning in early September at 7am (when I should have been studying for my test). I am so grateful to the VIP staff and medical and dental team for this big community of love and service. I can’t wait to see what the final day of clinic holds.

Words can’t begin to explain the bond and friendship that I have made with Cydney. I am going to attempt to explain how much he has impacted me this past 10 days as well as our team. Cydney has a dynamic and impactful personality. He is well respected among his village. He comes from humble beginnings and does not take anything for granted. Cydney has such a big heart and is loving and caring towards his people as well as the Americans.

As my translator this past week, Cydney has taken me under his wing. He has taught me many words in Chichewa which has allowed me to see more into the lives of the villagers we have interacted with. He has also introduced me to foods that are favorites of the Malawian people. I have had the opportunity to try sugar cane, sweet potatoes, papaya, nsima, and cassava. I was also blessed with the opportunity to be welcomed into Cydney’s home which helped shine light into Cydney’s life. He grew up as an orphan living with his uncle and cousins, whom he refers to as his father and brothers and sisters. Through the help of his family and VIP, he is now in his second year of university. He is studying communication with a minor in theology at African Bible College.

He has aspirations to join the ministry because of the love and care that VIP has provided him. Cydney also takes a big role in his church and can be heard singing aloud on Sunday’s.  Cydney has shown me the reason we need to break down the walls that may be dividing us, and I am happy to say I now have a friend and brother who lives across the world from me. I know that he is going to continue to inspire and help his people. I can’t wait to come back and see the positive impact that Cydney has made on his village and the Malawian people. Zikomo kwam biri my mchimwene Cydney. 

This morning, eight of us woke up at 4:45 AM to go help the village of Ntambo inoculate chickens against Newcastle Disease.  This is a virus that has ravaged the chicken population in Malawi.  Because of Newcastle Disease, VIP has had to suspend its program of chicken distribution to the most vulnerable families until they could get the disease under control.  Now VIP helps the villagers inoculate their chickens every 4 months.

We arrived at 5:30 AM along with the sunrise.  After being greeted by the chief of the village (a woman!) the villagers all brought their chickens to the center square in the village. So many chickens! Entire families came with chickens. There were chickens in baskets. There were chickens in buckets. There even were chickens carried in their hands.  Little children arrived swinging chickens nonchalantly by their feet and wings. There were roosters and newborn chicks, and we took care of them all. VIP staff member Charles Sokoso explained to the villagers and the Americans how to inoculate all of these birds. It was surprising how simple the process was.

While each villager held a chicken, we grabbed its beak, turned its head and put a single drop of vaccine into one eye.  When we weren’t busy giving this medicine to the chickens, we were able to cuddle with the baby chicks and play with all the children. It was a great morning and definitely worth it even if we did have to get up at the crack of dawn!

Villages in Partnership works in conjunction with each of the villages’ “VIC”, Village Implementation Committee, to identify the most vulnerable families in the area to visit. This allows our American team to gain some insight into the daily lives of those they are serving. Today, I travelled to the village of Disi and was welcomed to Addada’s home. Her actual name is Patuma but everyone calls her Addada, a term similar to “grandmother” and one of endearment. She welcomed us to join her on a straw mat outside of her home which also happens to be what she sleeps on at night. She doesn’t know how old she is but says that she was about 10 years old around the great famine in 1949 – putting her around 80 years young.

We asked her questions about her household, how her harvest was, how far she has to walk to access water… questions that one would rarely, if ever, ask in the United States. Her 14 year old granddaughter, Shalom, lives with her because Addada can no longer take care of herself. At 14, Shalom is Addada’s sole care provider. Shalom works in the garden in hopes to harvest enough food to feed her and her grandmother, she carries water on her head and helps manage Addada’s health. It was heartwarming and incredible to witness this young woman care for her family with little to no resources. Having helped care for my own grandmother, I appreciated how special this was and how difficult it must be. It was a privilege to be invited to their home and I am humbled by my time spent with them. 

On my second visit to Malawi I was asked to take on a new venture.  VIP had acquired a package of eye glasses and lenses through their partnership with Global Vision 2020.  This consisted of 250 pairs of frames and a variety of corrective lenses.  But the key feature was a device which is worn like glasses which has a plastic piece on each side which can be adjusted with a wheel to change the setting.  We would first test a patient’s vision using an eye chart taped to the wall and identify on what line their vision started to fail.  Then we would use the device to identify what corrective setting cleared up their vision.  Using setting on the plastic piece we could then select the specific lens from a case of lenses and snap them into the frames.

The real significance of this project is that these people had no access to glasses before we brought this here.  In many instances, when the new glasses were placed on the patient, their face brightened up with the realization that they could see clearly.  We also brought reading glasses in various strengths.  Again, the reaction from the people when they could clearly see the words in their medical passport was very rewarding.  Wearing glasses myself, from a young age, I can appreciate how beneficial they will be.

We are trying to make this program a sustainable one rather than something that only happens with the clinics.  One of the group that ran the eye clinic portion of the clinic was a local Malawian teacher. I trained him on how to conduct the exams and how to assemble the glasses.  He then did most of the exams and the interaction with the Malawians while I assembled the glasses from the resulting tests.  To keep the program sustainable, we charged about $1 for each pair of glasses. This should be enough to cover the costs of replacing the frames and the lenses and to generate a small profit for the teacher.

Another aspect of the eye clinic was the participation of a local Malawian eye doctor.  Many of the people who showed up at the eye clinic had problems with their eyes that were not related to glasses and he was able to provide assistance through drugs from our pharmacy or through a referral to the local hospital for proper treatment.  Again, this access to eye care is something which does not normally exist in the villages.  We are now looking at the opportunity to add eye care to the ongoing clinic services.

This July, I returned to Malawi with VIP for my second medical trip. As a nursing student, I had experience with patients and hospitals, but never imagined a healthcare system like Malawi’s. When you don’t know where your next meal is coming from, it’s hard to fathom why you should care about a mosquito net over your bed or why you should get that sore on your leg looked at. You do your best to survive in an unforgiving environment with little resources. Malawi’s hospitals differ so greatly requiring family members to support the patients’ needs including meals while getting treatment. Going to the hospital as a mother means leaving your children home alone or with a relative to care for them. Going to the hospital as a child means having a family member come and cook for you. The hospital means taking time away from harvesting fields and providing food for your family. Treatment is often withheld until the disease progresses, making it even more difficult to treat.

My first day in the medical clinic my instructor, Lucy Goeke, said that I was needed to help a patient that just arrived. She told me the patient was an injured young girl named Aristina and that I should prepare myself. I entered the room with another instructor, Jackie, and immediately was taken aback. The young girl was my age, in her early 20’s. The mother told us, through our interpreter, that the girl was epileptic, suffered a seizure, and fell into a fire. Her shirt was holding on by threads as the fire had devoured the skin on both of her arms and even more so on the girl’s chest and breasts. She was covered in blisters as the burn had just taken place earlier that morning. We were limited so we applied ointment to the blisters and kept them from drying to the bandages we placed to keep infection out. The next day she returned and we were able to debride the burns and clean the edges to allow for new skin to grow. Another day passed until we saw the girl again. She seemed in much better spirits as the burns were feeling less painful. We set her up with dressings and arranged for her to return weekly to meet with a Villages in Partnership clinician. VIP employees and several clinicians came to continue care and meet with the most vulnerable patients. Leaving the girl in the hands of a Malawian clinician made it much easier since we had trust in their work. I received an update about five months later showing her progress and that only made me want to return to see her more.

Returning to Malawi this past July, I was amazed to see Aristina in such good spirits along with her family. We were welcomed to sit with her and the family as we conversed over how the past year had gone. Her burns were fully healed and she was smiling from ear to ear, something that I had yet to see. The mother said that Aristina stopped talking after the incident since it was so traumatic to her, but recently started talking again. Aristina faces many obstacles living in a rural village, but because of the care she received from the VIP clinicians, infection will not be one of them. When VIP asked the villages what they could do for this region, they responded saying the number one resource needed is access to healthcare. Building a clinic nearby means quicker access and less detrimental outcomes for villagers. The clinics treat illness along with disease and help with prevention including of fetal abnormalities and sickness by providing prenatal care through VIP’s partnership with Vitamin Angels. The clinics also offer access dental care. The dental clinic grows each year, continually advancing. Not only has VIP been able to remove teeth through these clinics but now they have been able to save people’s teeth and conduct cleanings. VIP supports thousands of Malawians and I’m incredibly grateful to have had the opportunity to be a part of a wonderful team enriched with heartwarming people.

When we walk into the dusty clearing surrounding a quaint little hut, an old man hobbles out to meet us. He calls something in rapid Chichewa to a couple boys nearby. They run and grab some burlap sacks on which we sit to avoid getting our cloths too dusty.

After we are seated, he totters over and greets each of us. After greetings, he sits to talk. The sweetest eyes peer out from his round face and a toothless smile stretches from ear to ear. We are immediately charmed.

We are here for a home-visit, an essential part of every trip to Malawi – even for the medical team. Amidst the busy days of clinic, it is important to find time to come, be present, and chat with some of the most vulnerable families. It invites insight into the lives of people who live without secure food sources, without dry spaces on which to sleep, without clean water.

Today we are visiting Levision Dulana at Mpoola village. I am with my Mom, a team member named Carol, and our translator, Sydney.

“We are here to learn a little bit about your life,” Carol tells him. “Is it ok if we ask you some questions?” (Sydney is translating everything).

“Of course, it is fine,” he replies.

“Who lives with you?”

“A 13 year-old grandson, but he is gone now for Chinamwale in the Simba.”

Chinamwale is the initiation of boys to men – they are circumcised at the beginning and then spend a month secluded in a tent with men, learning about many… things. I shudder imagining this traumatizing experience as a 13-year-old.

We talk for some time – his story is like many others. He lives alone because his wife left when he grew too ill to work. He did not harvest enough food to last the year. He lives with the boy because he cannot care for himself. But the community helps him, sending aid. He is still not sure how he will make it. God will provide.

Finally, my Mom returns to the initial conversation. “Abambo, can you tell us about chinamwale? Or is it a secret? What do you learn there?”

To all who venture to Malawi, I encourage you to spend time with my Mom – she asks the best questions!

“They teach the boys to respect their elders. They tell them they must work hard or women will not like them. But I can tell you nothing else.” He chuckles. “There are many things regarding women!”

“Do you expect your grandson to be a better helper when he returns? More respectful?”

“Of course!”

When conversation dies down, we ask him if he has any questions for us. Questions about our lives, America. He retorts – “I have never left this village! How should I know what I should ask?” He laughs some more.

At the end of the visit, we present him with some gifts, including a pair of soccer cleats. He lights up. Although he can barely shuffle around the house, he tells us he is an avid soccer player. The toothbrush makes him smile even more – “I have only 1 tooth – it will be a clean one!” He points to the back of his mouth.

As we take leave, my Mom takes a picture of us together. “Will you bring me this photo so I can tell my friends that I hosted azungu (white people)?”

“We will try – next time we come, maybe we will dance together because the vitamins will make you so strong.”

“Next time you come, I will be on the football pitch!” He says, bent at a right angle because he cannot support his body upright. He sends us off with his laughter echoing through the air.

A few days ago, Sokoso, our veterinary officer, told me that a happy man lives long. I think this old man has many years yet to live.

This medical mission trip has proved to be one incredible journey. This is my first time in Africa, first time doing a mission trip, and my first time being a part of the Villages in Partnership. To say I was overwhelmed, at first, is an understatement. I had moments of pure doubt in myself, but knowing that I am doing all that I can for the Malawians truly is something special. The team has been such an incredible group of people all coming together to do something bigger than ourselves. Being in the clinics truly put everything in full circle of how we are helping these people. I am so thankful to be a part of trip, to be here with the team, and to help in any way I can. The clinics can be overwhelming with so many people who need relief and are in pain, and to be able to help these people is nothing short of amazing. To be a part of a group that is doing all that they can for others with nothing in return is phenomenal. In the clinic, today, I met this young girl with a deep wound on her leg. The entire time we were washing, cleaning, and bandaging this wound, the girl made no sound. However, you can see it in her face that she was in extreme pain. It is this kind of bravery and courage that kept me going throughout the day. The Malawians are such strong and incredible people, and I am so blessed to be able to give them my time and energy in order to give them better outcomes. What a trip so far!