Caltech

Favorite moments in Malawi

For my last post on this blog I'd love to share with you some of my favorite moments I had while in Malawi.

I LOVE to sing so the teaching time at clinic was really enjoyable for me!

 

 My favorite day was at Liwonde National Park where we got to see probably a hundred elephants!

 

I took this video while we rode down the Shire River. You'll see and hear hippos, warthogs, and a yellow baboon!

The above videos are just some of my happiest moments in Malawi. I had such an amazing trip and I'm so grateful that I was there. Thanks go the Studenski Award for generously paying my way to Malawi and Project Peanut Butter for hosting me! While I was in Malawi I was able to explore medicine in the third world, to learn about my own personality and dreams, and to refine my career goals. Being in Malawi convinced me that I want to be a doctor for the developing world which definitely encouraged me to switch my major from mechanical engineering to biology.

Thanks for reading! It's been so great to be able to share this trip with you!

Kate

A day at clinic in photos

Hey everyone!

I'm back at Tech! I'm going to use the amazing high speed internet here to share more photos and videos that I couldn't post while I was in Malawi. Enjoy!

Let's start with where I was living in the city of Blantyre, Malawi. This is sunset from outside my door:  

Every morning the rest of the team and I woke up early therefore we saw amazing sunrises coming over the mountains on our drive out to the health centers.

 

When we arrived at clinic we set up the scale, the height board, and got to work. 

 Many times the children jump off the scale and run away! And if they are crying too much while they're on the scale the digital read out won't be able to calculate their weight! Thankfully, the child below was extremely well behaved!

 
After a weight measurement it's off to the height board:

The kids don't like the height board either! Based on their weight versus height we can identify each child as healthy, moderately malnourished, or severely malnourished. Based on that classification we give them certain amounts and types of therapeutic food. One caveat to add, if a child has kwashiorkor malnutrition (explained in a previous post) they are classified as having severe malnutrition regardless of weight vs. height.

Next, the mother goes to talk with the nurses to learn about the food and children who are new to clinic try the food in front of the nurses. One reason the nurses have the new children eat in front of them is to judge the health of the child. If the child is not eating it is the most likely case that that child must go to the hospital that day to receive life saving care. 

This test feeding is going well:

When all of the moms have gotten to clinic the nurses will do some teaching through word and song:

That's a day at clinic, in photos!

Possibly True

The following is an amusing and possibly true story:

While sitting at the dinner table in Namandaje, a village to the north, we all raised our glasses for a toast. As we clinked our glasses I said "Cheers!" and drank up. My mirth was quickly outstripped by uproarious laughter from the other end of the table. Ben, the Peace Corps volunteer mentioned in a previous blog, had said "Mipondo!" instead of "Cheers!" and all the Malawians were dying of laughter.

Don't feel bad, the humor was lost on me as well.

As it turns out "mipondo" is the Chichewan word for "chairs."

I agree, saying "Chairs!" isn't funny. Well not yet, it isn't.

The story goes that British nationals would be eating and drinking in the then protectorate, Malawi, and would clink their glasses to the shout "Cheers!" But the British accent being what it is, some Malawians hear the word "Chairs."  Wanting to share in the custom, Malawians began to drink to "Chairs!" and the word has stuck ever since!

Latrines and edema

Half of Project Peanut Butter spent Wednesday night at Namandaje village, north of Blantyre.We go their once a fortnight (yes, people say fortnight in Malawi) as a home away from home when we go to very distant villages. It allows us to treat three health centers in two days that are much too far from Blantyre to otherwise serve. We stay with a Catholic priest who has done amazing work in his village! I was so impressed by the medical and educational facilities he was able to support and expand on.

Here is Ben (pictured right), a Peace Corp volunteer posted in Namandaje, explaining the latrine project he worked on to me and Ricky (pictured left), a medical student working for Project Peanut Butter.

 

This project of Ben's is so powerful because it's sustainable! A group of parents whose children attend the primary school approached him about getting four more latrines built. There had only been a handful for the 2,000 students! Ben worked with them to write a grant, and a short while later the latrines were built. Ben found out later that the parents he worked with went on to raise even more funds, without his help this time, and built about eight more! The people at the school demonstrated that they now have the skills to plan out a building project, to raise funds, and to implement the plans after this small push from Ben! It's every exciting and bodes well for the village that they are making huge strides towards improving quality of life with being dependent on outsiders.

Ben recently taught a health class at the secondary school. The culmination of the class was to design some sort of project to improve the health of the community. One group of students had an idea for a hand washing station for their latrines. Ben helped them to make an action plan to implement it and voila! The students built them! Ben is doing such a great job helping the Namandaje villagers get done what they want to get done!

Below are pictures of a boy we treated the day after we were in Namandaje. The boy suffers from kwashiorkor malnutrition. It appears that medically kwashiorkor is not well understood. At its root, though, in this type of malnutrition the body starts collecting water where it shouldn't be collecting. Typical cases that I see children with kwashiorkor have water pooling in their feet. In children with more severe cases of this malnutrition the water collection, edema, spreads farther up the legs, perhaps to the knee, and shows in the hands and face. The diagnostic tool we use at clinic to determine if swelling is this kwashiorkor caused edema is a simple thumb press into the skin. We push our thumb into the skin for five seconds, withdraw and if there is a discernible pit in the skin after two seconds there is edema.

This boy has severe edema. His face is so swollen that his left eye can't even open.

 

This is the boy's foot after I pressed my thumb for five seconds.

Given the effectiveness of the peanut based food, RUTF, that we give out at Chiponde Clinic, this boy will very likely recover fully from this acute bout of malnutrition within two months. Having seen this boy last fortnight, I can gladly say that his edema is actually resolving!
 

I've been at clinic long enough to be able to see children I enrolled with edema look healthy again and to see very skinny children look a bit chubby. It's all very exciting!

Kate

Mulanje District, Malawi

I spent my weekend in the staggeringly beautiful Mulanje District of Malawi. The district saddles up right next to Mozambique, grows oodles of tea, and generally busies itself being gorgeous. The area is famous for its mountains and tea. I went there to spend time with Bri, a Peace Corps volunteer, and new friend. She lives about a 10 minute walk from one of the Chiponde Clinic sites, Muloza. Her house is in the traditional village style, being made of brick, with a cement floor and tin roof. It has three small rooms that serve as kitchen, bedroom, and storage. There is also an outhouse, a hut, and a room for bathing. After the grand tour of the premises, she has a beautiful garden, and chatting with the friendly neighbors that came to investigate about a person driving a car all the way to Bri's house we were off to hike on Mt. Mulanje.

Bri, Amy -Bri's good friend and fellow volunteer- and I hiked to this waterfall:

We swam in the pool there, but couldn't last for long. The water was FRIGID! Though cold, the water felt so deeply cleansing! I haven't felt so clean any other time in Malawi and I think Bri and Amy would both concur. Once we were driven out by the cold, we took to sun bathing and rock scampering. There were SUV sized boulders surrounding the pool that were great for scrambling and jumping! Climbing around was such a hootenanny and reminded me of the baboons and vervet monkeys we saw along the way.

What was the most common conversation topic? Being tired from the hike.

Second? Jane Austen. I had to travel across the world to meet people that are as hard core fans as myself! I did discover that tea time, so integral to the British in Austen's novels, is also a social norm in Malawi! Chombe tea, grown in Mulanje, is a delectable tea comparable to an Irish Breakfast tea. 

The morning after the hike we needed to get cooking water for Bri. So she gave me her water bucket, a smallish one because she is kind, and led me to the nearest borehole. There we met a group of six mothers filling their water basins. Bri, in Chichewa, explained that I needed to learn how to get water. The statement was met with grins and giggles. My unlearned behind was scooted up to the borehole and I started pumping water while Bri cleaned the bucket. I started to fill it with water, but the mothers heckled Bri for not properly cleaning it! So she washed again and then, and only then, was I allowed to fill it to the top (lots of pumping!). Before I could put the bucket on my head, Bri rolled up a chitenje as a makeshift pillow to cushion the bumpy bottom of the bucket (Seriously, in a country where women carry things exclusively on their head, why aren't the buckets flat on the bottom? Come on people!). But, of course, the mothers weren't pleased with how she did that either. Again, much laughter and smiles. The chitenje/pillow was refolded by Rose, a friendly neighbor. Pillow in place, the bucket on top of that, and off we went back to Bri's with many cheers and laughs! A successful trip as I didn't even spill any water! I totally cheated, though, and used my hands to keep the bucket in place! Getting water was such a fun experience because the give and take with the moms was so light, fun, and natural. With my very little Chichewa I was able to joke a little, Bri much more so, and we all laughed and hugged around! The moms were so funny, helpful, and jolly! It was such a joyful interaction, perhaps my favorite yet in Malawi.

Look at these smiles!

 

That's authentic, Malawian water on my head! And, yes, I know I'm a hussy for not having a chitenje on.

Other exciting parts of village life:

-Using the outhouse! Aim is very important when the hole in the ground is tiny!

-The neighbors were about to bake bricks so they were cutting down a tree today.

-The Limbuli Market, an outdoor market about an hour from Bri's house, was pretty happening. A huge selection of clothes and food and everything less expensive than in the city! Mandazi are these little fried dough balls that cost ~6 US cents. Delicious and dangerously inexpensive.

It was such a fantastic, fun weekend and I'm so glad for the momentary immersion in village life!

Kate

TGIF

TGIF! The end of Ramadan is a national holiday in Malawi so clinic was extremely slow today. It seems that mothers were either celebrating the holiday or assumed we would not be on site. It is unfortunate for those children that did not get their necessary supply of chiponde to see them through this next fortnight. On the way back from clinic the roads were full of people walking to and from the mosques, it was quite festive and exciting! There were LOTS of food vendors!

Our clinic site today, Thondwe, is unique from the others because it is a Millennium Village. Here is an excerpt from Wikipedia about the Millennium Villages Project:

"It is an approach to ending extreme poverty and meeting the Millennium Development Goals--eight globally-endorsed targets that address the problems of poverty, health, gender equality, and disease. Initiating a paradigm shift, the Millennium Villages promote an integrated approach to rural development, using evidence-based technologies and strategies in each sector, with sufficient investment over a sufficient period of time. This approach also combines a critical cost-sharing and planning partnership with local and national governments, and rural, African communities, while focusing on capacity building and community empowerment. By improving access to clean water, sanitation and other essential infrastructure, education, food production, basic health care, and environmental sustainability, Millennium Villages ensures that communities living in extreme poverty have a real, sustainable opportunity to lift themselves out of the poverty trap."

I can't say anything about the effectiveness of this particular project as I see only the Chiponde Clinic one in two weeks. The difference I do see between Thondwe and the other clinics is that this site has 60+ health workers, while most other sites have ~10-20. It's great that so many people are educated about health and well-being, but it also means that when these health workers rotate through our clinic once every few months they don't really know how clinic runs! What a problem to have: so many workers that they can't help as well! Crazy.

If you recall, there has been an measles outbreak in Malawi. I've seen children at Chiponde Clinic that are on the recovery from it. At clinic today we heard word that three of the children should have been there today all died of measles. Three in one day! That these children died of a preventable illness really isn't that shocking to me anymore, but today having three at once was devastating to the spirit. The effect of the measles outbreak is more tangible than ever as I come into contact with those children who have recovered and the mothers of those who have not. 

There appears to be a diesel shortage! Woah! How very 1970s. It appears to be a fairly regular event in Malawi. I don't know the cause of the current shortage, but I know that one in the recent past occurred because the diesel suppliers to the country could not exchange the Malawian kwacha for any desirable currency! Currently, there is still petrol, but that started to run out during the last shortage. At least for now we  can get around with our petrol truck!

Kate

On safari!

I spent my Sunday at Liwonde National Park on safari!

 

We drove through a herd of elephants within the first 15 minutes of being there! I had been warned not to get my hopes up, but luckily saw so many elephants. We saw four different groups of elephants in total. This first herd, pictured above, was the largest at one time with approximately 30 members that we could easily see. As a biology nerd, and just being a person, this was awesome to see! We probably sat in our car for a half hour watching them and only tore ourselves away because we knew we would see all sorts of creatures on the boat ride later.

In fact we saw all sorts of animals on the Shire (that's pronounced Shear-Ay, not like in Middle Earth) River. I was super excited a week ago to have seen nine hippos, so imagine my happiness at seeing dozens and dozens, maybe up to a score, of hippos on Sunday! There were also yellow baboons, vervet monkeys, monitor lizards, fish eagles, kingfishers, wart hogs, impala (and lots of other similar animals), savannah buffalo, and crocodiles. Lots of crocodiles. And, what's a safari without a cheesy photo next to a crocodile?

 

I know the photo is almost too small to really see (darn internet!), but that isn't a log I'm so excited about. It's a crocodile taking a nap! Actually, giggling and jostling in the boat woke it up, scary! It's left forearm stops above the elbow and is all scarred over, a fight with a fellow crocodile perhaps?

Every time we saw some amazing phenomenon I kept thinking, "I'm so lucky!" and "It couldn't possibly get any better!" but then it always did. The most amazing experience was last. We were actually way over the allotted time for our tour, but our guide spotted an elephant totally in the water so he drove up over to see it. We were able to get really close and watch him cool off! Then we looked to our left and there was a whole herd of elephants! A man, kind of off to the side, once he saw us from a hundred yards away very resolutely and regally walked towards us. Straight at us! He didn't seem agitated,more curious than anything about us. Reaching the edge of the water didn't stop him. He would have walked right up to the boat if our guide hadn't started the engine in time! The elephant's march was so majestic! What a great note to end the day on!

I'm blown away everyday by the wildlife I see, the people I meet, or the experiences I have here! Translation: More students should apply for the Studenski Award!

Environmental concerns

Bricks, they are quite controversial. 

What you see here is a finished pile of bricks ready for some mortar. These bricks have been left to sit here for days to cool off. There had been fires burning in each of the three gaps in the pile. The fires burnt for three or four days straight in order to dry out all those bricks. While the fire was burning the pile may have been totally open to air as you see it in the photo, or the people may have packed mud onto it in an attempt to insulate it. In either case it is hugely inefficient to heat the bricks in that manner. The wood keeping these fires burning is huge in the volume and adds to the already alarming deforestation in the country (recall the charcoal poaching issue I mentioned in an earlier post?). And poor Malawi, going into the dry season this month, needs to carry the burden of brick making right now! The brick making process requires vast amounts of water, such amounts that rivers dry up! Being just before the dry season many people are rushing to make their last bricks of the year, but the rush only exacerbates the onset of drought!

These brick piles are EVERYWHERE. I haven't been outside of the city without seeing tons of these bricks on my drive. Knowing that these bricks drain the environment so I have been wondering how one would attempt a "better" brick. My thoughts usually settle on a project fellow Techers worked on for a class last year. Mechanical Engineering 105: Product Design for the Developing World is an awesome class that makes better technologies for developing nations. Last year a team went to Guatemala to figure out how to design a better brick making oven. I was blown away by the presentation they gave at the end of term! They had many brilliant innovations, two stand out to me right now. They replaced wood with cocoa shells. Cocoa shells are hugely inexpensive and are an otherwise a wasted resource. Brilliant. I wonder if there is a similar resource in Malawi? Maize stalks? Their oven was also completely enclosed, hugely increasing the efficiency of baking. Better efficiency is, of course, a good goal but it brings a whole new set of problems. An enclosed oven for bricks means that there is some central location and company making bricks. The current system in the Malawian countryside is that the bricks are made right on site! Would the people be interested in buying bricks from an outside supplier? Is it even possible to make and transport bricks for less money than the current system? How could a company break into this market and advertise? Is there a way to also reduce water content in bricks? You get the idea...These are the kinds of questions running through my head each time I see these brick piles.

Bricks are just one engineering dilemma here. There are also dilapidated bridges and roads, a lack of irrigation, running water, and electricity, a new railroad being put in place, etc. An engineer would be quite busy in Malawi, quite as busy as a doctor. The question I keep asking myself, as per the spirit of the Studenski Award, is whether I am more excited to jump into issues of design or health? Infrastructures or medicine? There is so much to do in both fields! So many ways to improve living conditions, to serve. What to do...what to do...

Conflicted,

Kate 

A weekend at Lake Malawi

Disclaimer: This entry contains information as communicated by an enthusiastic biology nerd.

You ask: "How was your weekend, Kate?"

"FANTASTIC!" I reply.

Now, let me tell you all about it!

I spent the weekend at gorgeous Lake Malawi. Imagine the most perfect beach in California (palm trees and all), add hippos and monkeys, trade the irritating salt water for fresh, and shoo away all the people. You are now imagining Lake Malawi. The main events of the three days were: wildlife sightings, snorkeling, swimming, and kayaking. Could it get any better? Yes, yes it can. Add reggae music!

Early Saturday morning Alison, a fellow volunteer from Northwestern U, and I hired a motorboat to take us to an inlet where the local hippos live. We had to approach every slowly; the engine was hardly pushing us forward as we tried to sneak up on the hippos. We dared to get within 30 to 40 yards of the hippos! There were nine of them! NINE! They were quite loud, snorting and blowing. The hippos sounded like whales and dolphins when they empty out their blowholes. Their cute little ears were flapping away as the hippos meandered about the water. They stayed around for bit while we looked on; they seemed quite content being fat fatties. Eventually, though, they submerged and seemed to travel into the reeds. 

After that adventure we sped off to an island not far from where we were staying. The island is part of the Lake Malawi National Park and as such is quite untouched. There were just a few landing sites for tourists to stop to have lunch, but otherwise no evidence of human tampering. Being tourists, we did stop for lunch on the island. After eating kampanga, catfish, caught that morning we spent hours upon hours snorkeling. It was my first time going snorkeling. Wow, was it breathtaking- figuratively and literally. It was around three quarters of an hour before I was comfortable and proficient with the snorkel. Once comfortable, I fell in love with the sensation of extended submersion! Uninterrupted viewing underwater is enthralling, amazing, unique! I was blown away by the number and variety of weird, vibrant, curious fish. My favorites included a zebra-like black and white stripped fish, an electric lavender fish (if that color could be possible), and a white and sea-foam green fish with blue eyelids that made it look like a teenage girl learning to apply makeup. The time snorkeling was fantastic both in the beauty of the lake floor and the full engagement of my mental faculties. I hope to snorkel again, and perhaps, even scuba dive! A girl's gotta dream!

The rest of the day was spent relaxing: reading Vanity Fair, practicing guitar, or playing bawo. Bawo is a board game played by many Malawians. If you have ever played mancala you would be quite comfortable playing bawo within a few, quick minutes. The games are extremely similar, the main difference being that the board surface is really two mancala boards pushed up next to one another creating a 4x8 well surface; you can Wikipedia bawo to see a picture. If you see me at Tech I would love to play with you! I am afraid that I am not a challenging opponent yet, as everyone I played let me win. All the people I played owned local shops and wanted to encourage my patronage.

That night Alison and I went to the reggae bar. I was SO out of my element, goodness! I much prefer sitting on the beach to dancing with strangers, listening to waves instead of Bob Marley, and counting stars to counting beats. So, I did leave the bar a bit early to hit the beach instead. An early night brings us to an early Sunday morning. By seven a kayak trip was in the works and at half past eight I was circumnavigating the nearby island in a kayak instead of by snorkel. My new vantage point above the water encouraged me to view the lizards and birds of the island.

I spotted a monitor lizard about four feet long! It walked with that characteristic reptilian wiggle/swagger and its tongue was constantly zipping out from behind its teeth. Later, I watched the fish eagles hunt. They look a lot like bald eagles, having a white head and dark body of similar size. Fish eagles, however, have dark brown coloring. The most surprising aspect of the eagles was their caw! They sounded so like sea gulls! A pathetically mundane call for so majestic looking a bird. I also saw kingfishers, of poetry fame. I had assumed that that kingfisher would be, well, kingly in both size and appearance. But, to my surprise, it is a rather small bird of banal patterning. I must, however, bow to its prowess as a fisherman. The kingfisher is a wildly successful hunter, despite their shocking antics. When they dive they dive straight into the water. The THWONK of the bird hitting the water's surface is audible from quite a distance. I am so impressed that that tiny bird's frame can take the abuse.

As wonderful as all these sightings were, the highlight of kayaking was during my paddle out to Otter's Point. I had hoped to see otters, but given the daylight, my hopes were misplaced. Little did I know I was in for an even greater treat: baboons! There was a whole baboon troop traipsing over the rocks on the mainland opposite Otter's Point. They walked around the rocks with a nonchalance that suggested they were unaware of their powerful sway over my mood. I was mouth agape in wonder for the half hour they graced me with their presence. They were doing their baboon thing and I was so pleased to watch as they groomed, played, and climbed. The young were goofy, the mothers caring, and the males intimidating. Fascinating. Their disappearance into the countryside coincided with my departure time from the lake, so thus closes this blog. 

Peace Corps, Hard Core

I've just spent a wonderful evening hanging out with two Peace Corps volunteers, Bri and Amy. They're great! They both work in Mulanje district Malawi. It's the most gorgeous part of the country (that I've seen thus far). The plants are luscious, the greens vibrant, and the mountains breathtaking. 

They have both been in Malawi for six months mostly learning Chichewa, the Malawian language, and getting their projects started. They will both be here for two years and are hoping to do great things for the villages in which they live. Bri is working in the environmental sector. She has a few projects she's working on; an important project of hers is getting a tree farm off the ground. Deforestation is a huge concern here. Charcoal i.e. burned timber, is totally illegal in Malawi but many people burn down the forests, collect the charcoal and bring it to market. The aim of the tree farm will be to repopulate the forests around the village. More trees in this mountainous region could prevent fatal mudslides and also raise the water table. A higher water table keeps more bore holes, wells, functional and the water in them purer. Amy is currently working on installing a new bore hole near the local secondary school. The bore hole is primarily for providing porridge to the students of the school. A praise worthy aspect of Amy's work is that she is trying to address the issue of foreigners showing up in this Malawian district handing out very helpful, expensive aid and quitting the area. She is attempting to train local leaders to write grants for themselves. Thus this bore hole will be paid for with a grant written by the Malawians! "If you teach a man to fish..." It's awesome. 

Meeting them has been a grounding experience for me. I live in a bubble here. Amy and Bri fill buckets with water at the bore hole and carry it back to their homes everyday. They have made friends with the people they're living with, which is something I very much envy about their experience. For me, the people I see with any regularity are just those few people I work with and they all, thankfully, speak English well. Amy and Bri are investing so much time here than an understanding of Chichewa is paramount and they are already communicating very well. I, realizing that a language is beyond my ken for just a six week immersion, have not attempted to learn Chichewa. I know enough phrases that I can communicate what I need to when I talk/motion with mothers at Chiponde clinic but that is largely the extent of my knowledge. I am finding that I am living vicariously through both Bri and Amy's stories about life in their villages! The idea of becoming a local has started to have a pull on me, but my novel reading has given me quite the ability to romanticize any experience even, Amy was just telling me, the fact that she had to kill a poisonous snake in her outhouse with a machete! 

I'll be going to spend a weekend with the two of them sometime during my stay to get a better feel of life in rural Malawi. I look forward to it! In the mean time, I leave to go the Lake Malawi tomorrow! It's a World Heritage site because, well, it's gorgeous! There will be time to kayak, snorkel, and read on a hammock on the beach...it's a tough life.