I'll Try to Limit the Sad Posts From Now On

So I’ve been in Malawi for two weeks now. This past week was my first of six weeks at Nkhoma Synod Hospital. One can find it on Google Maps. It’s about 50 km northeast from the Chadabwa/Mitundu area I was working in as a Peace Corps Volunteer. I have been and will be working mostly in the pediatric ward at the hospital. We’ve had 80+ patients each day, with a turnover of about 20% each day due to new admissions, discharges, and deaths. This is an absurd number of patients given that the staff is at most three nurses, two clinical officers (somewhat similar to a physician’s assistant in the States), one doctor for only half the day, and me and two other medical student who barely know what the hell were doing. This is the maximum staff we have. Usually, most of these people are either out in the parking lot talking with friends or hiding somewhere thinking about how tired they are. But that’s a rant I’ll go on a different day. Today, by briefly explaining three patients I worked with this past week, I want to give you a picture of how bad the situation is here, especially now as the rainàmosquitoesàmalaria ramps up.

I didn’t really take care of this first child because there was nothing to do by the time she got to the hospital. She was about one to two years old and suddenly developed malaria at home. The story I heard was that the family lives in a very rural area on the outskirts of the hospital catchment area. There’s a very basic health center near to there home, and when the parents took the child there, the staff quickly told them to go to our hospital because her illness was so severe. This is a distance of about 30 km over muddy, washed out, hilly roads. Unfortunately, the health center’s ambulance was broken. Then were told to get the child here on their own. This time of year, most families have miniscule cash reserves. The yearly cycle of cash flow from selling portions of one’s harvest reaches its nadir around this time, and basic things like arranging rapid transportation to the referral hospital become very difficult. The parents managed to scrounge up enough cash to hire a motorbike to bring them to the hospital. This was the only motorbike in the area, and apparently it had some problem so that it could only get up to a maximum speed of 10 km/hr. On the steeper hills it lost power, and the mother with child in hand had to get off and walk. About two thirds of the way to the hospital, the motorbike completely broke down, and the mother had to carry the child the rest of the way. By then, the child was seizing. By the time they reached the gates of the hospital, the child was dead.

There was another child, a cute cubby little 4-year-old boy, who I hadn’t seen until after he had been in the hospital for a few days. He also had malaria, and it was confirmed that the parasite had gotten into his brain (called cerebral malaria) on the second day of admission. Before I saw him, he was seizing on and off for a few days and combative at times when awake. The nurse had asked me to see him because he was acting strange after he seemed to have recovered the previous 24 hours. I went over to his bed and saw him sitting in his mother’s lap with her barely able to hold on to him as he was flailing around and biting her at times. He was laughing at the same time, and at first glance he just looked like your typical problematic toddler. I told the mother that he looked much better and full of energy! She gave an awkward laugh but then shook her head and briefly stated that he was acting very strange. I watched him for a bit and realized that his eyes were darting all over the place. He was calling out the names of people that weren’t there. He was swatting at flies that weren’t there. A couple of the other clinicians and I brainstormed what was wrong: HSV brain infection? Rabies? Psychotic episode? We couldn’t figure anything out that day and couldn’t really settle him down. The next morning one of the doctors saw him, and she immediately proposed the idea that he’d simply lost all his vision. I flashed my penlight over his eyes and he didn’t react at all. We ended up having the ophthalmologist come up and take a good look at the retina of each eye. He confirmed our suspicion. We concluded that he lost his vision due to the malaria infection in his brain. Given that he is young and his brain is still developing, there is a chance some of his vision will return, but most likely he will remain blind the rest of his life. I was choked up as I broke this news to the family.

The saddest story for last: The doctor and I were seeing a new patient. Again, this one had severe malaria (pretty much every patient we admitted in the last week had malaria +/- other stuff) and looked pretty bad. We were asking the mother about what was going on with the child, and I asked her weather anyone else in the family had been sick recently. She offhandedly said her husband died the day before. I’m fairly decent at Chichewa, but I often mishear things, especially when people use words/phrases with double meanings. I was surprised but what she said and thought maybe I was mishearing her so I called over the nurse to make sure we were all on the same page. We were understanding each other, and we quizzed her a bit more about the husbands death to see if might be related at all to the child’s illness (for example, did he have TB that he might have given the child?). It didn’t seem like he had any type of contagious disease so we moved on trying to figure out how we were going to treat this very sick child. Without going through all the details, I’ll skip ahead to the next morning. Most days, the majority of the medical providers at the hospital meet up at 7am for Morning Report. This entails discussion about what happened on each ward overnight and maybe a brief lecture on a certain topic from time to time. The clinical officer that was on the peds ward overnight described how this child had declined quickly and passed away a few hours prior. I can’t imagine how that women felt first loosing her husband and then loosing her last-born child the next day.

At least one baby/child has died in the ward every day I’ve been here. After living in Malawi for over three years and knowing how dysfunctional things can be here, this doesn’t surprise me at all. It only makes my angry.

The guesthouse I'm staying at, just up the hill from the hospital. I don't have any evidence yet, but I still think it's haunted.