Author: Dr. Barbara Edwards | Princeton, NJ

Yesterday we left N’amanghazi Farm and drove to Liwonde National Park about 2 hours away for a safari.  We stayed at Mvoo Wilderness Lodge, which was a lovely resort with a center lodge and chalets along the Shire River in the National Park.  There are tons of hippos in the water as well as Nile Crocodiles.  We went on a late afternoon safari and stopped at the river’s edge for a drink at sunset.  How lovely!  Just our group and the hippos!  We saw gazelles, wart hogs, waterbucks, and lots of birds.  Dinner was great: delicious ham (a nice change from chicken and goat) and yummy vegetables.  Lots of them!  The chalets were lovely with big stone bathrooms and comfy beds under a giant mosquito net.  We were right on the river and could hear the hippos all night.

Today we went on another safari in the morning at 5:30 driving through the rhino preserve.  We did not see any rhinos or elephants but we saw kudus and other animals.  It was like an amusement park ride, going through ditches and tall grasses. Then we returned for a delicious breakfast of eggs and toast and marmalade and fruit salad.  In the afternoon we went on a boat safari on the Shire River.  We saw hippos and crocs and fish eagles and marsh eagles and from very far away – elephants!  It was a beautiful day. After a delicious lunch we drove back up to Balantyre and we stayed in a conference center there overnight.  What a fun day.

Tomorrow we leave for home.  I’m looking forward to seeing my family but I am sad too.  What a fabulous experience this has been.  Both medically and spiritually this has been an adventure and journey that we will not forget.

Wednesday was a great, fun, exhausting day. I think we are all a bit tired from everything we’ve already done this week. We never stop moving here but it is always interesting and fun. On Wednesday, most of the group went to visit local primary schools.  We helped to clean the schools by sweeping with the local homemade brooms (made with small branches held together in your hand) and then mopping with old t-shirts on their hands and knees. We went to visit the classrooms where they spoke with the students. The students had lots of questions such as,” What do you eat in America? What do you do for fun? How many languages do you speak? Do you have HIV/AIDS in America? Did you bring a car over with you on the plane?”

While the rest of the group was at the schools, a few of us went to a village to help cook our lunch. We prepared a large community meal for well over 100 people. We cooked outside under the trees over small fires that they built between bricks. They used corncobs, sticks and corn stalks for fuel. We chopped greens, shelled peas and pole beans, and ground nuts (peanuts). We ground up the peanuts with a giant mortar and pestle and added them to the food. We also roasted peanuts and ground that up for the most delicious peanut butter I have ever tasted. We fetched water from the well and carried it back to the cooking area about 200 yards on our heads! We also helped to cook nsima, the local version of cooked cornmeal.  To complement the nsima we made “relishes” that are eaten alongside: mustard greens, pumpkin leaves, and sweet potato leaves cooked with tomatoes and ground nuts, okra, and pigeon peas; and goat cooked with tomatoes. All the food was delicious! We sat on the ground in groups of 3-4 and ate out of shared bowls using our right hand. Yes, we wash our hands beforehand by pouring water from a cup over them. After the meal we all thanked the village and the chief for providing such a wonderful meal for us! We all feel blessed to be here.

After the meal we went to see Triza and gave her grandmother medicine for her cough.  We passed a large funeral for a chief who had hung himself.  No one knows why.  We also stopped at a store that sells chitenges, the large cloths that we wrap around ourselves every day.

Now we are packing up.  I can’t believe that we leave tomorrow for the safari.  I am looking forward to it but I am also sad to leave Zomba and the people of VIP.  They do a lot of good work around here.

Today we started the day with a meeting to discuss the successes and challenges of the 3 days of clinics as well as the way forward to address these challenges. It is interesting to see how things changed over the years as they learned how to do things better. They have organized things better each year and they were very open to improving things even more in the future.  Examples of ideas for improvement included adding a morning huddle at each clinic with the prescribers and the pharmacy to clarify what meds are available.  Another was to have a laminated cheat sheet, which showed the difference between American and Malawian medical abbreviations.

In the afternoon we made home visits.  We visited a girl named Triza who is sponsored in part by our church (Nassau Presbyterian). We presented her family with gifts and we presented her with a school uniform. The uniform fit her perfectly and she seemed delighted.  I think it is rare that she gets something new.  Apparently she is an excellent student: 3rd in her class of 60 fourth graders.

We then visited 2 other families. One was an older woman and her blind husband who lived with their granddaughter.  The girl was 9 and goes to school.  The grandfather is unable to do anything because he is blind so the grandmother does all the farming herself. We were able to go into their house, which was made of mud bricks and had a tin roof and glass windows.  It was clean and I was glad to see that they used mosquito nets.  They had no electricity or running water, of course.  It gets dark at 5:30 so it is difficult for the children to study at night.

Our last family was a 90 year old woman living alone.  Her son and his family lived next door.  She still farms on her own but only harvests 1/2 bag of corn.  She also has chickens living in her house with her. One hopes that her son helps her out when she runs out of food.   She lives in a mud house with a thatched roof.  She reports that it was built in 1984 and that the thatched roof needs to be replaced every 4 years.  It does leak in the rainy season. We gave each of the families blankets, clothes, vitamins and we examined them and treated any illness that we found.

Today was the last day of clinic.  It was incredibly busy but we all worked faster and we had learned how to treat the conditions we are seeing here.  We saw tons of malaria. At one point we ran out of malaria test strips (a quick test for malaria that we could do with a finger stick). We had to treat empirically for the symptoms until they brought new ones from another clinic. I learned that most people know what it feels like when they have malaria, so I could use their impressions as a guide as well.

I had to make a home visit to a woman with a fever who was unresponsive.  She had a stiff neck and a positive malaria test.  I was worried that the stiff neck signaled meningitis so I had the ambulance bring her to the hospital 15 minutes away.  However, she just may have had a seizure due to malaria.  In that case, she might have been better off getting treated at our clinic.  We had better IV meds for malaria than the hospital.  Often if we treated with IV meds at the clinic the patient would wake up and improve enough to go home and could then finish the malaria treatment at home.  It was not an easy call.

At the end of the day we all took pictures and exchanged emails with the Malawian medics and translators.  One makes friends quickly in such an intense situation.

Tonight after dinner we sat in a circle in the classroom and talked about what was best about the day.  I talked about going on the home visit and then walking back to Kalupe Clinic because I had sent the ambulance to the hospital.  I kept meeting people along the way. I recognized what a privilege it was to be welcomed into people’s homes and villages.

The medical resident I went with talked about how she was angry on the first day of clinic because we had to see people so quickly but also how she realized, by the third day, that it was the only way to see the volume of patients that we needed to see.  We saw almost 5700 people in 3 days in 4 clinics.  We saw 679 the last day in our clinic alone.  I know that we saved hundreds of lives just counting those who would not have been able to get malaria meds because the government clinics were out of stock.

VIP also trains medics in Malawi who then work in the villages for at least 5 years and provide continuity of care throughout the year.  They also dig and maintain wells, build schools, train teachers, build roads and bridges, and give families goats and chickens to maintain their food supply.  (In Malawi there are chickens and goats everywhere, and they live in the houses with their families.  Somehow they find their way home at night.)  VIP also brought electricity into Kalupe, built a corn mill for the village, and is now building a rice mill as well.