Out of Africa.. but hopefully not forever

NB. This post does repeat some of the things I mentioned in earlier blog posts, but writing it has allowed me to “reflect” on my overall experience.

In September and October of this year I was privileged to spend 6 weeks working at Nkhoma Mission Hospital in Malawi. I had been part of the mission team from Bishop Hannington Church, Hove that went to Malawi to work with SCOM (The Student Christian Organisation of Malawi) in July 2008 and, following this experience, was very keen to return. As part of my medical degree I had the opportunity to go and practise medicine anywhere in the world- my choice was simple!

Nkhoma Mission Hospital is a rural hospital with approximately 220 beds, set in the beautiful mountains of central Malawi at an altitude of 3,300 ft. The hospital aims to provide ‘good healthcare motivated by the healing ministry of Jesus Christ’.

The hospital is currently very short staffed- during my stay there was only one trained doctor who worked alongside seven clinical officers and two medical assistants who have 3 or 2 years training respectively. Praise God that prayers for staff are being answered, and in 2010 there are several doctors and other healthcare professionals going to Nkhoma to serve.

On the road to Nkhoma in a mutola

Each day in the hospital began at 7am with morning report and staff prayers. This was followed by ward rounds on Mondays, Wednesdays and Fridays. Tuesdays and Thursdays were theatre days for the clinicians so medical students would do ward rounds on these days. After ward round I would go to the Out Patient Department (OPD) or to Casualty. In OPD I saw patients on my own with a translator and saw a huge range of interesting pathologies. In Casualty I was able to do minor operations such as abscess drainage, suturing wounds and splinting fractures- the theory was “see one, do ten yourself” so I had to learn very quickly! I also attended main theatres twice a week where I learnt to administer spinal anaesthesia and assisted with procedures including prostatectomy and hernia repair.

I spent much of my time working on the Children’s Ward where I was involved in the care of the patients’ right through from admission from the Outpatients Department until discharge home- a level of responsibility I have not yet encountered as a medical student in the UK. We often had 50+ patients on the ward but this was set to quadruple soon after I left as the rainy season comes and malaria cases become even more frequent. During the weeks I was there the daily admissions had already gone up from 6 a day to 12+. This meant that I was often called upon to come and assess if any children were well enough to go home because of a huge shortage of beds! I found this tough because I was sending mothers and children home at 5pm knowing that they had several tens of kilometres to walk and that it would be dark within an hour- a sad reality.

There were some very stressful and emotionally draining experiences; for example being the only clinician on a ward when a baby stops breathing and attempting to resuscitate with very limited equipment. It was also difficult as many of the patients came to the hospital when they were already very sick and despite our best efforts there was very little we could do for them. God was so faithful in giving me the strength to cope with these situations and I was constantly reminded of His complete and absolute sovereignty over all things.

Outweighing the difficult experiences were the positive ones. The Malawian people were so friendly and welcoming- they renamed me ‘Sarah Nabanda’, (Nabanda is a common Malawian surname), accepting me as one of their own which was a great honour and very humbling. The times I spent praying and fellowshipping with the staff, local church members and missionary families are ones that I will never forget.

Some days I would go home from the hospital feeling really sad because I felt sure that a particular child wouldn’t make it through the night as they were so sick and there was no more we could do for them. I prayed for my patients each evening and, praise God, many times children who I thought were too sick to survive made it through and were able to go home a few days later.

I was at Nkhoma to primarily to serve by helping with the medical care in the hospital, but I also had the opportunity to be involved in some of the Mission’s other ministries, including Bible Clubs which are run weekly for children living in the surrounding rural villages, and it’s work with the ‘Farming God’s Way’ initiative aiming to equip local farmers with biblical principles alongside new agricultural skills and technologies.

Unfortunately halfway during my time at Nkhoma I was diagnosed with a severe form of malaria and had to be admitted to the hospital as a patient myself. Thankfully the treatment was very successful and after resting I was able to continue my work.

During my first week at Nkhoma two of my patients had cardiac arrests while I was with them and we were unable to resuscitate them. I felt completely out of my depth and wasn’t sure if I would be able to cope with the whole 6 weeks. A chapter which really helped me at this time, and throughout my time at Nkhoma, was 2 Chronicles 20 and in particular verses 12 and 15. In this chapter Jehoshaphat, the King of Judah, is faced with a huge army coming against him and seeks help from the Lord; “For we have no power to face this vast army that is attacking us. We do not know what to do, but our eyes are upon you.” (20:12b). God speaks to him by His spirit through Jahaziel encouraging Jehoshaphat to not be afraid or discouraged, saying that “the battle is not yours, but God’s” (20:15). He has faith and the next morning even instructs the men of his army to go out singing God’s praises “Give thanks to the Lord, for his love endures for ever” (20:21), and they defeat the Ammonites and Moabites.

I didn’t face any huge armies in Malawi but this chapter helped to remind me to pray and rely on God in all situations and to praise him for his goodness and faithfulness.

Relaxing at Lake Malawi

My time at Nkhoma was the most challenging and yet rewarding experience of my life so far. Once I am qualified as a doctor, if it’s God’s will, I would love to spend more time working abroad in a Christian hospital in a resource poor setting.

Time to say goodbye

Yesterday was my last day at Nkhoma Mission Hospital. The past 6 weeks have been life-changing for me. I’ve learnt such a lot about God, myself, tropical medicine & paediatrics, human emotion, Malawian culture, cooking with limited ingredients, slaughtering goats, etc etc… it’s hard to know where to begin.  I’ve met so many unforgettable people and have made friends for life.

I hope to write some more blogs in the coming days/weeks sharing more stories of my experiences working in the hospital but for now here are some photos of my final days….

The baby boy I delivered by Caesarean Section.. yes, I did a C-section!!!

With Richard- the Nurse in charge of Childrens Ward

Eating Cassava at the market with Daniel and Sam- I was only posing...raw Cassava "isn't for women" as it apparently increases sperm numbers in men.. or "top up"!!!

Doing my last ever ward round on Paediatrics with Sam (Deputy Medical Officer)

Outside the guesthouse- my home for the last 6 weeks

M is for mosquitoes, malaria, meningitis and Moffat!

I haven’t been able to get on the internet for aages- except facebook which I can get on my phone- but I think most of you know I was quite sick the week before last.
The evening after I wrote my last blog entry I was very sick and had a fever, I spent the following Sunday in bed resting-still with a fever and abdominal pain- so Monday morning decided to go the hospital laboratory to do a malaria screen. Unfortunately it was positive..the lab technician even showed me the slide under the microscope. Thankfully because I’m on prophylaxis I was only 1 + falciparum malaria- so it was the nasty sort, but a weak strain. I was started on LA which is the treatment for uncomplicated malaria but unfortunately I continued vomiting and so on the Tuesday had to be admitted to the private ward in the hospital to have Quinine (Qnn) through an IV line. It was very weird receiving Qnn as I’ve been prescribing it so much over the last few weeks. Unfortunately the nausea and vomiting persisted so I had to have 3 of my doses IV- which made me feel pretty awful. Malaria makes your blood sugar go low and so does Qnn and by Tuesday evening I was very very hypoglycaemic- so much so that I couldn’t walk or speak coherently! Thankfully Janneke (a nurse from Holland who lives in the guesthouse with me) was working on the private ward so she looked after me during the day and set up the IV line overnight in the guesthouse Tuesday night so she could keep an eye on me! I spent another day in hospital on Wednesday but by the evening was feeling much better  A side-effect of the Qnn was that it made me quite deaf and gave me awful tinnitus- but thankfully it stopped when I finished taking the quinine. A week ago I tested negative- woohoo! Which was fortunate because that day a pregnant lady needed an urgent blood transfusion and I was the only O negative member of staff in the hospital so I had give her some of my blood!

I missed a whole week in the hospital while I had malaria so was really eager to get back the following Monday. I’m on paediactrics now which I absolutely love!! It was hard because within a day I had seen 2 children die and had to resuscitate several others (successfully). The responsibility I’m given is incredible… after my introduction to the ward by Sam (the medical officer for paeds) I was left to run the ward pretty much on my own. Sam taught me to do lumbar punctures (LPs) and since that first supervised one I’ve done 10 more on my own- my nickname on the ward has become “LP Queen”! Often the way it works is that I see children in outpatients, admit them, prescribe medications and then see them each day on my ward round- Sam does ward round with me twice a week so I’m able to get his advice on tricky cases. I’m really thriving with the responsibility- it’s meant I’ve had to learn so much so fast but it’s such an amazing sense of achievement when you can discharge a patient home who you admitted when they were very very sick. The main illnesses on the ward are malaria, meningitis, pneumonia and malnutrition. As a medical student in England we don’t ever prescribe medications but here I’m prescribing all day every day- I think I recite dosages in my sleep! Currently there are over 50 patients on the ward but this will quadruple in the next few weeks as the rainy season comes and malaria cases become more and more frequent- even in the last few days we’ve been admitting 10+ patients a day when before it was only about 4 or 5. This means I’m often called to come and assess if any children are well enough to go home because we have a huge shortage of beds at the moment! I find this tough because I end up sending mothers and children home at 4 or 5pm knowing that they have several tens of kilometres to walk and that it will be dark within an hour. But unfortunately it’s the way it has to be. The ward will be extending in a week or so because currently maternity is in half of it while the new maternity ward is being developed.

I’ve seen hundreds of children over the last couple of weeks but a particular child that sticks in my mind from my time on paeds is a little baby boy. He was admitted with severe pneumonia and malaria and commenced on IV antibiotics, anti-malarials and oxygen therapy. I was called to see him late one afternoon on the female ward (he’d been sent there because there was no electricity on the paediatric ward that afternoon so they couldn’t give any oxygen therapy!!!). He looked very sick when I saw him- was short of breath and breathing very fast with audible crackles that you didn’t need a stethoscope to hear and secretions from his mouth and nose. I had to do an LP to check for meningitis because his neck was very stiff. After I’d finished the LP the baby stopped breathing and had no pulse so I had to resuscitate him- I called for help but there were no other clinicians around so I did it on my own. I was praying as I did it and praise God after a little while I felt a pulse and he began to make an effort to breathe again. Dr Ter Haar came soon afterwards to assess him and told me there was nothing more we could do for him- he was getting all the meds he needed and oxygen so we just had to hope he’d be strong enough to keep breathing. I went home feeling really sad because I was sure he wouldn’t make it through the night- breathing was exhausting for him and I felt sure it was only a matter of time before he stopped. Later that night I was passing through the hospital on my way home from seeing a friend and I went in to see how he was doing- to my amazement he had his eyes open and was breastfeeding!! He continued to get stronger and improve on treatment and a few days later he was well enough to go home!! Happy ending! 

I have so many more stories to share… such a lot has been happening here. With every day that I spend here I realise that it is going to be harder to say goodbye a week on Friday. There are ups and downs but the ups definitely outweigh the downs! My experiences working in paediatrics is definitely making me think about coming back and doing work here in the future which is exciting!

Hope all is well back home… it’s weird that it’s becoming autumnal in the UK- here in Malawi it is continuing to hot up each day! Please continue to pray for the work of the hospital.

p.s. I couldn’t write a blog post about m’s without mentioning Moffat the clinical officer for anaesthetics! He’s such a legend! and has such a cool name!

Sitting in the heat in Lilongwe…

I’m currently sat in an internet cafe in Lilongwe- the air con isn’t working so it’s really hot!! I just wrote a post which some how disappeared so I shall try and write it again quickly. We travelled in by minibus this morning and 2 of my housemates Katrin and Isabelle made the mistake of taking photos at a road block just outside Lilonge- they were taken out of the bus by the police and into a little hut by the side of the road. Simon and I were left in the minibus and didn’t know what was going on, but thankfully they returned after about 5 mins- the police had wanted to take their cameras but settled for them just deleting the photos they took- phew!!

Time here is flying by- I had my last day on female ward yesterday and the mark the occasion Gert-Jan (the other med student and I) went to the local pub with some of the clinical officers from work. The pub is on a hill side just outside the village- it’s a missionary village and no alcohol is allowed in the main part. We walked there by torch light following the lights ahead and loud music playing. We found our friends and soon we were all drinking Carlsberg Green- the drink of choice in Malawi! We were the only azungus there and I was the only female- thankfully our friends protected us (mostly me) and got rid of any unwanted attention! Gert-Jan is pretty good at pool and they were playing winner stays on- the locals were loving it as he beat player after player but was finally unseated by a quiet guy who’d patiently waited his turn.

This week I joined the local church choir which is really fun! We sing some songs in chichewa and some in english and it can be quite hard to keep up as they all know all the words and harmonies (and sometimes dance moves!) off by heart, but i’m getting there and will hoefully be singing with them tomorrow in a choir festival in our village.

Nkhoma is feeling more and more like home now. I’ve made great friends in the guesthouse and I enjoy going to work knowing that i’m going to see stuff i’ve never seen before and learn loads, also the banter with my colleagues is great-they always cheer me up when things get me down.

Thanks so much for all your prayers Please continue to pray for my work in the hospital- I am moving to paediatrics on Monday so it will feel like I’m starting all over again and there’ll be lots of new things for me to try and learn and new staff to work with. Please can you also pray for tiredness- work starts at 7am every day and the days can be very long, hot and busy. There’s so much to thank God for- for friendships, peace when i’m working in the hospital, great opportunities for sharing my faith with people I’ve met and my health is improving again after being a bit sick at the beginning of the week which is good!

It’s week 2 already!

Well, it’s the beginning of my 2nd week here at Nkhoma. Phil and Chris came to get Kat yesterday so there were some tearful goodbyes- it’s been so great having Kat staying with me and seeing her & the physio Dawe around the hospital- he looked quite lost this morning without her! Was particularly hard saying goodbye to Chris- but roll on Heathrow Arrivals!

So much has happened in the last few days. I’m settled in well at the guesthouse now- the other guys staying there are great- we cook dinner together, sunbathe, hang out, play games- i’m slowly improving at the traditional malawi game ‘Bao’… it’s nice

Hospital life:  there are frustrations each day and I still haven’t quite adjusted to the way things work here- ward rounds may or may not happen, there may or may not be a doctor available to review a patient (with only ONE doctor for the whole hospital it can be tricky!) etc…. but i’m working hard and doing as much as I can. Death is not a taboo here as it can be in the west- each evening I head off having checked on my patients, praying that they will make it through the night. Often they don’t. There were a couple of very sad deaths last week.. I won’t share the details here, but they knocked the wind out of me a little.  I’ve had to accept that without our help a lot of the people who come to us would die, and even with our help they are often already so ill that there is little that can be done with the resources that we have. It is a comfort to remember that God is in control. I’ve made good friends with several of the clinical officers- they’re a good laugh and have been really supportive when i’ve had a bad day.

But it’s not all doom and gloom- i’m learning SO SO much every day in the hospital I really enjoy running clinics in OPD and i’ve done loads of procedures and minor operations- abscess drainage, suturing, excision and foreign body removal, leg debridement, ascites tapping and plaster casts for fractures to name but a few.

Daniel is the clinical officer who specialises in orthopaedics, A&E and minor surgery.. he is training me to be a surgeon (i haven’t got the heart to tell him I want to be a GP!!)… he says a good surgeon must have:

1. The heart of a lion
2. The eyes of an eagle
3. The hands of a lady

He invited Kat and I over for dinner on friday night. He told us that he was planning on killing a goat for us all to eat. This didn’t shock us as it’s very usual for people in Malawi to buy animals alive and then kill them at home as this is much cheaper than buying them pre-prepared. However, I didn’t realise that Daniel had plans to work on my lion heart that evening by making ME kill the goat. Apologies to any animal lovers… but I did. I killed a goat!!! (and it tasted really good barbecued!!).

Another highlight of my weekend was helping out at a 10K race to raise money for Africa Burn Relief- was a really fun afternoon with most of the village turning out to watch.. it is really hot here- over 30 degrees every day with wall to wall sunshine- the locals are obviously used to this (unlike me!!) however after 10K of running a couple of the competitors were struggling. The doctor from the hospital and his family had come along in the afternoon to watch and he and I ended up putting up an IV line in the middle of the field for one poor guy!

I have so many more stories to tell and am meeting so many amazing people… hopefully i’ll be able to blog again soon and put some photos, but i’m not holding my breath as the internet here in the village is v v slow.

Thanks for your messages and prayers. Please continue to pray- especially for work in the hospital and homesickness. Please also pray for health- i’m feeling a little dodgey today. I’ve met some really nice christians and am joining a bible study group tomorrow eve which i’m looking forward too.

Nkhoma Mission Hospital- first few days

I have finally managed to get on wordpress- the internet and computers here are painfully slow- it takes around 25 mins to send an email!! Kat and I arrived safely at the hospital on Saturday afternoon and sunbathed, relaxed and got to know the others staying at the guesthouse. For dinner our first eve we had chicken (which we had seen being killed by 2 of the other residents!!) and nsima (a local malawian food).. Kat and I also both tried mouse!!- i wouldn’t recommend it!!

On Sunday morning we went to church- both the english and the chichewa services which were cool, then it was back to the guesthouse for more sitting in the sun and chilling out..i could get used the slow African pace of life!!

Monday morning was a different kettle of fish. Work starts at 7am each day with the morning report and on wednesdays a service in the chapel. Then on mon, wed and fri it’s ward rounds- on tues and thurs we just go and see the really sick patients as it’s theatre on those days. After ward rounds (for my 1st 2 weeks i’m on general female ward) I head over to OPD (outpatients) where I see patients on my own with a translator and then discuss them with a doctor or clincal officer. Unfortunately the hospital currently only has 1 doctor so he is in demand!! CLincal officers have 4 years medical training and can do ward rounds and clinics and some operations. On my first day, amongst other things, I came across the largest prostate i’ve ever felt, drained an inguinal abscess in casualty, prescribed various drugs on my own(!) and helped do the dressings for a baby with burns on it’s face.

I have to head back to the ward now so will try and blog again with more info soon. Work here is hard and emotionally and physically draining. I’ve never been so challenged by anything. But God is working powerfully and i’m praying lots and growing a lot spiritually. Today I heard about a womans bible study which another girl from my guesthouse goes to- big answer to prayer!

Please email or facebook me with news- it’s great hearing from you when i can get on the internet

Lake Malawi

Yesterday we returned to Lilongwe after a few days by the lake. We travelled by bus down to Monkey Bay before getting into an open top truck to travel down to Cape Maclear. This was a new experience for me- when we got on it was already full of people (12 or so) and I wasn’t sure if there would be room for us but by the time we reached the cape it had stopped to pick up lots more so there were 30 of us hanging off the back of the truck!!

We stayed at a lodge called Fat Monkeys which was great and really relaxed- we could see the beach from our rooms and hear the waves lapping against the shore. Cape Maclear is the only place on the lake where you can watch the sunset over the lake itself and we took full advantage of this both evenings…

A photo I took of the sunset on the second night

On Wednesday Chris and I went on a boat trip to a small Island. We went snorkelling off the rocks while a couple of guys cooked us lunch over a fire- Chambo with rice, potatoes and a tomato sauce..mmmm! There were thousands of brightly coloured tropical fish- it was an experience I’ll never forget.

Chris snorkelling

After lunch was more snorkelling and then we got back on the boat to go and see some fish eagles. Simon our guide threw some fish into the water before making fish eagle noises-squawking! Then the eagles would swoop down and grab the fish before flying back to a tree to eat!

Other highlights included: drinks in the beach bar, learning to play Bao- a traditional Malawian game, local children playing, singing and dancing for us.. SUNSETS

..Phil and Kat arrived today..Tomorrow I head to Nkhoma Mission Hospital with Kat to begin my 6 week placement, while Phil and Chris head south to do some work with SCOM. Please pray that I’ll settle in quickly at the hospital and make friends (Kat is only with me for the first week). Please pray for safety on the roads as we all travel and that we’ll all stay healthy- praise God so far we’re keeping well.

We’re here!

Chris and I arrived safely in Malawi yesterday lunchtime. The flights were ok- I wasn’t able to sleep on the first overnight flight, but got some sleep lying on a floor in Nairobi airport while Chris stood guard!- and our bags managed to arrive with us despite stops in both Nairobi and Lusaka.

Our friends met us at the airport and then drove us straight to the restaurant they have recently bought- they’ve had really tough year but it was great hearing how God has been working in their lives- using bad situations to bring about good stuff- and how they’ve trusted in Him for everything.. was also great to have a really nice lunch in their restaurant sitting in the afternoon sunshine after cramped seats and plane food!! We’re so blessed to have such amazing friends here who love us and look after us like we’re family

Last night we had a movie night with Steve and Michele, Michele’s mum and sister and some other missionary friends of theirs- great just to chill. Today we’re having a lazy day reading, sitting in the sun and hanging out with the family as they come and go from the house- they have very busy lives! Tomorrow we’re heading to the lake to a place called Cape Maclear for a couple of nights to have some beach time and do some snorkelling before I start at the hospital on Saturday.

Otterspoint at Cape Maclear where we're heading tomorrow

Stand firm. Let nothing move you.

‘Therefore, my dear brothers, stand firm. Let nothing move you. Always give yourselves fully to the work of the Lord, because you know that your labour in the Lord is not in vain.’

1 Corinthians 15:58

Ok, so it’s 2am, I’ve had a really long day, but sleep is just not happening!! I think it’s down to a mixture of lying here thinking too much & worrying/nerves/excitement about heading off on Saturday! I’ve come across this verse from 1 Corinthians several times in the last few days in a book and on several overseas missionary society websites connected with Malawi.

In 1 Cor:15 Paul’s been talking about Jesus rising from the dead and saying how he can be sure this is the truth- after all if Christ was not raised, us Christian’s are wasting our time. I really like  verses 54b-57: ‘ “Death has been swallowed up in victory.” “Where, O death, is your victory? Where, O death, is your sting?” The sting of death is sin, and the power of sin is the law. But thanks be to God! He gives us the victory through our Lord Jesus Christ’.- the prophesies from the Old Testament in Isaiah and Hosea quoted here have been fulfilled! Through Jesus Christ we have victory over the grave.

Paul’s encouraging the Corinthians, who are Christian believers, to keep going- that even when things get really tough they should remain rooted in the gospel and their faith should not be shaken. To work for God, because that’s the best purpose we can ever find!

Childhood memories

I just saw this advert on tv… bit of a blast from the past reminding me of many happy days spent watching Postman Pat at my grandparents house

There are some half decent adverts around at the moment- i’m not ashamed to admit that i’m quite a fan of Aleksandr from Compare the Meerkat- the ads never fail to make me smile!… apparently there’s currently a petition to get ’simples’ put in the Oxford English Dictionary!