Pepani!

I was recently accused of both neglecting my blog and for having a depressing last entry.  Pepani! There is much to write about and I promise to update more regularly.

First, my last entry was about low enrollment.  There were days when I felt like I was going to be here for years trying to get enough patients enrolled.  The good news is that enrollment is picking up! I named one of the counselors the recruitment champion, and for the next two weeks, despite 2 public holidays, we enrolled 6 and 15 patients respectively (compared to 2/week during the preceding 3 weeks).  I made a point to recognize her at our clinic meeting and to give her a round of applause.  I asked one of the receptionists to nominate someone for the next week and so this week I am making it a point to acknowledge the current recruitment champion for our robust enrollment figures.  The current champion feels invested, the receptionist who nominates the champion feels invested, and the rest of the staff talk can look forward to their week in the spotlight.  So, like I noted before, I am making progress pang’ono pang’ono.

In other work news, I started spending one day a week on the inpatient medical ward at the hospital.  It’s completely scary to start thinking about medicine again, but also really fun to see patients and get motivated to read about interesting things like the different causes of meningitis and how to distinguish them just based on the clinical presentation and very limited labs or the various extra-pulmonary manifestations of tuberculosis.  I saw one patient who was admitted through my study.  My community counselor had traced her as a partner to an enrolled index and as part of the study procedures we did a CD4 count for her (not typically standard of care as part of HIV diagnosis here - a patient has to attend a treatment facility to be evaluated for their treatment eligibility).  We traced her in the community again because her CD4 count was dangerously low indicating she was severely immunocompromised and needed medical attention asap instead of waiting for her 7 day follow-up visit.  The situation illustrates that late diagnosis is clearly still a problem in Malawi, and was also satisfying because she was successfully treated for pneumonia and TB and initiated on anti-retroviral treatment.

Off to the lake...

In my spare time I have been frequenting Lake Malawi.  The last weekend in March I went to Mangochi for the Malawi Aquatic Union National Championship, a 1 mile lake swim.  I “trained” for it with one lunchtime swim of 1300 meters at the African Bible College pool.  The venue was Club Makopola, by far the most luxurious lakeside resort in Malawi...think wide, white, sandy beach, clear blue water, and lush foliage.  The swim itself was difficult; my arms were burning before reaching the first buoy and I cursed myself for signing up many times under water (the only thing keeping m

e from grabbing on to the support boats was my pride).  But I emerged as the women’s open division winner (age 18-32) with a new course record.  Now I have something to aim for next year! The rest of the weekend was spent kayaking and relaxing at Cape Maclear, the site of Lake Malawi National Park.  Cape Maclear is my favorite kind of lake experience.  The accommodations are all very basic - either backpacker-type or campsites - and they are interspersed with the village.  You really get a sense for how important the lake is to the Malawians living on it as you share the beach with women washing clothes and pots, men fishing, and children playing.

Sunset at Cape Maclear

The following weekend I went to Senga Bay, the closest spot to Lilongwe.  The water was uncharacteristically rough that weekend, so instead of spending a lot of time I water activities I climbed a nearby hill and was rewarded a good view of the surrounding lake and villages.  

Finally, Easter weekend in Nkhata Bay on the northern lakeshore.  We arrived on Saturday afternoon and immediately signed up for a “Full Moon Party” on a nearby beach.  We missed the first two boats out and ended up on boat in the middle of Lake Malawi for the incredible moon rise.  The moon rise was amazing - it was like a giant fireball emerging over the horizon - quite an experience! The rest of the night was spent drumming and singing around the fire with the local villagers and eating traditional food.  We missed the first boat back and ended up on a boat with about 5 azungus, 15 Malawians, and all of the drums.  It was so festive and joyous and impossible to describe with pictures or words.  The boat ride back at midnight was filled with even more drumming, singing, and dancing.  It wasn’t until we were about 5 minutes from shore that I noticed a boy at the back of the boat had been bailing out water with a bucket!

Back to Lilongwe...

Last weekend I spent in Lilongwe, doing HIV testing, running trails, and dancing to reggae.  A friend of mine organizes HIV testing events for Grassroots Soccer and had set up a small testing event at an AIDS support organization in one of the outlying areas in town.  Once again I was overwhelmed by the generosity of my study staff as 5 volunteered immediately.  There is not the same culture of volunteerism in Malawi as there is in the U.S.  Life here is hard, the jobs don’t pay very much, and it’s a challenge for most to just take care of themselves and their (extended) families.  This testing event was run by a different organization, did not include any payment or “credit”, was not part of their job description, and took place on their day off.  Yet, they must at least believe that what they do matters a little bit, and they can make a difference? Anyway, it was a great morning with over 70 tested and lots of opportunities to play games with enthusiastic kids.  One little girl grabbed my hand at the beginning of the morning and didn’t let go until I had to tear myself away to drive my counselors back to Lilongwe.  

Someone brought a CD player, prompting a dance party and a dance-off (won by the smallest kid there...he could move!) 

In the afternoon a few of us drove out to Kumbali Village, a lodge and cultural center 10km out of town to try out a trail run on their newly groomed trails along a river (side note: the lodge is where Madonna stays when she’s in town).  It was so fun and peaceful to run real trails again! Reggae night at a local club capped it off.

So...that was the last month.  More to come soon...