Photo: baby on sister's back

One of many small people being transported by a big sister. This was taken at a football tournament for school kids run by an organisation that promotes HIV testing in children.

First day working at KCH

I have ventured to the hospital today, after being ill for the first few days of this week. I'm in medicine at the moment, and the day starts with handover at 8am. At handover are lots of clinical officer students (second and third years - three year course), an intern (junior house doctor) who has been on over night, then a couple of registrars, other interns if you're lucky, and the head of medicine Dr Namarika, our supervisor and the only medical consultant. At handover we get a brief run down of the admissions, discharges, and deaths in the past 24 hrs. It’s quite hard to understand what they are saying because of the accent and quiet speech, and the diagnoses and differentials are obviously very different to back home. Basically, malaria, meningitis, sepsis, severe anaemia, lactic acidosis, or a combination. A clinical officer is then supposed to present a case to the group, sometimes they do, today no-one had prepared anything, that’s typical apparently.
Then we head of to our wards, Kate in doing female medicine, I am on the male side. There were 18 patients reported at handover, but there is a corridor full on the balcony outside, must find out if they are included or not! A ward round was started by one of the registrars. We started in the admission room, 6 old iron beds. The first patient we come to speaks a little English. The clinical officer student presents the case to the reg. He has been vomiting blood. The reg asks the student "how much blood"? Student: "I don't know". Reg: "how could you find out?". Student: "I don't know". We ask the patient. He says a litre, wow, thats alot. Then the reg examines him, and after feeling his tummy, he promptly vomits about a litre of fresh blood onto the stone floor. Covering most peoples shoes (I escape, and think, I really should be wearing my very unattractive protective eyewear all the time). This turns my stomach (I think because I am still ill, but also it’s quite impressive, I've never seen true haematemesis before). Everyone wanders off, and eventually the cleaners come and clear it away. I mutter something about how he shouldn't be on aspirin, and again the reg asks the clinical officers what aspirin does, and why we should stop it. They get it this time (he was prescribed aspirin when he presented with haematemesis, what was going on there???). Then I ask about getting a scope (camera test looking into the stomach), I don't even know if they have one at the hospital. Apparently they do but the surgeons will "send him back". What does that mean? And apparently the scopes are not for treatment, only for diagnostics. The reg doesn't seem very keen on my scope idea, probably because he doesn't think it will happen...not sure. He's not keen on a PPI (drug used to reduce acid secretion in the stomach) either, he doesn't know if the pharmacy has any. We move on to the next patient as the floor is still covered in blood.
He looks very, very sick. Apparently wearing a prison uniform. HIV positive (the previous patients' status was unkown). Mouth covered in sores, severe, bleeding oral thrush. No IV access so I assist the reg while he quietly cannulates the jugular (looked easy, I could try next time maybe, when feeling less wobbly). We give him fluid, and not much else. He feels very warm, differential: sepsis. But he looks sick to me, don't think he is a candidate for improvement. Meanwhile, another patient has been brought into the admissions room. On a trolley. Covered in a colourful sheet, head also covered. Very still. He's dead, must have died on the way to the ward from A&E. His wife is standing by, and when told, begins to wail. He remains in the middle of the room, people move him to get by, patients and staff alike. Eventually nurses come in to wrap him up, this happens in front of everyone.
At this point I am feeling rather weak and lightheaded. I've been on the ward about an hour, but that is all I can manage for one day! I feel a bit of a loser, but must be a bit soon to be getting fully involved. I did a bit, I taught a clinical officer about causes of haematemesis as he hadn't a clue what it was. I tried to get the reg to order a scope for the patient with haematemesis, he wrote 'endoscopy' in the notes, but not sure how far that will get, and we arranged cross match for blood transfusion.
So, that was my one hour today! Maybe I can manage something this afternoon, or tomorrow?

Senga Bay on Lake Malawi

After arriving at Lilongwe airport we made a quick getaway to the shores of Lake Malawi. Senga Bay is just east of Salima, a town about 100km east of Lilongwe. A great weekend of hot sand, big waves, frisbee, and Malawi G&T (MGT!). These photos show the beautiful flame trees and some of the many fishings boats that go out to fish at night.

Malawi: an introduction

Malawi is roughly the same size as the UK, and shares borders with Tanzania, Zambia, and Mozambique.