For 6 weeks I am doing a tropical medicine internship in Ekwendeni Mission Hospital in the rural North of Malawi with a Dutch doctor of tropical medicine who is here for 6 years with her family. I'm here together with Noortje, a friend and fellow medical student. The Malawians call her "Nola" (not Nora) as they seem to be unable to pronounce the "r". With this blog I hope to share some of my experiences here as far as that is possible mostly with photos but also some descriptions.
Ekwendeni, the small town where we live and the surroundings seem to be a tropical paradise. The majority of people are farmers. The bright red dirt roads weave through the brilliant green maize fields with a backdrop of dark blue mountains painted against the bright blue sky. Weaving down the roads are women in bright African prints with a baby slung on their back and a basketfull of cassava balanced on their heads. The colors are exuberant.
Sometimes this peaceful beauty seems in stark contrast to the severity of medical disease we see in the hospital. Severe malaria cases are currently at their peak with a different strain than usual and the pediatric ward is overflowing with young very sick children - up to 50 children admitted with severe disease in the ward that we review daily. Some children are coming in with anemia so severe that I did not know such a low hemoglobin was compatible with life. Another child whose body has been ravaged not only by severe anemia but also severe malnutrition, hiv and tuberculosis resulting in a comatose child who is no more that mere skin and bones.
The hospital is a fantastic location to learn a lot. It is small enough that we are able to review all wards during the day but also small enough to allow us to quickly consult different departments. We sometimes walk from the patient to the pharmacy to the lab to the radiology department and carry the dripping wet x-rays back ourselves along back with the patient. Anneke Snoep, the supervising Dutch doctor is a compassionate and caring woman who seems to stay calm but capable in the face of chaos, uncertainty and sometimes stressful medical situations. We couldn't as for a better supervisor.
Some issues in the hospital seem unique to life here and are unimaginable in a hospital in the Netherlands. Today the pharmacy is out of paracetamol, a basic inexpensive drug. Yesterday they claimed the pharmacy had no more malaria treatment but it seemed they had just issued the drug to the men's ward and it was lost in a cabinet. My first morning started out with a discussion about where the clinical officers (functioning as our equivalent to doctors) had been the past few weeks. Apparently here clinical officers sometimes decide not to show up and may be unreachable for days at a time. However, they are very needed so when they return they just resume where they left off. One clinical officer explained that he took a bus somewhere and could not have predicted it would take 10 days instead of 3. Just today we had a discussion about where a large sum of donated money meant to rebuild the neonatal ICU had gone because it had accidentally been put onto the wrong account....
Days in the hospital come with their ups and downs. Sometimes it is draining to be in the pediatric ward seeing a row of seemingly endless sick and crying children. At other times it is extremely gratifying when a very sick child in the ICU has transformed into a smiling lively child who is ready to go home. Sometimes it is frustrating when basic things you expect to work dysfunction. At other times I am very impressed by the successful medical interventions and creative endeavors that take place in a hospital with limited resources.
