Feet First

“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Sunday, October 06, 2002
    My friend Chuen-Yen finished her residency in June. She worked with me twice a week seeing patients as part of her training in outpatient medicine. Being a lover of travel and adventure (she went trekking in Nepal twice in the two years I worked with her), she volunteered to go to Malawi for a year to do volunteer medicine at a Seventh-Day Adventist missionary hospital. She has been sending us weekly e-mails which are simply amazing... such as this one...

    It has been an eventful week in Malawi. Although I treated several cases of Malaria, Schistosomiasis, Typhoid and assorted varieties of meningitis, the highlight was a weekend trip to Mulange.

    Mulange is a town (between village and city in size, prosperity and importance) 1.5 hours East of Blantyre by car and 4 hours East of Blantyre by bus. We were lucky enough to have a sub-compact car for 6 large, sweaty people, all our luggage and food for the weekend. Seatbelts are not an issue here. They don't really exist and overcrowding of vehicles is the norm. When we arrived in Mulange on Friday night, we had a quick (service in 1 hour) dinner at The Currypot, which serves only 3 different Malawan dishes, none of which has curry as an ingredient. Then we walked to a volunteer's house in the nearby village. The first stretch was along a dark highway, complete with speeding head-lightless cars and drunkards, while the last km took us on down a unlit dirt "road" with many treacherous rocks and ruts. Dust storms ensured that everything was red, including us by the time we reached the house.

    Because we had planned to hike, a torrential drought-terminating storm began with our arrival. 4 of us still opted to hike to Chambe plateau, which took 3 hours and 2500 meters of altitude gain. We had a porter / guide, selected from a mob of men screaming "pick me, pick me," to carry our pack. The
    pack contained 12 liters of water, 6 butter-cheese sandwiches, 2 jam sandwiches, chips and a loaf of bread. The gorgeous trail through dense vegetation and cloud forests culminated in a smouldering, black field of young pine trees (charcoal field). Apparently, charcoal is a major crop in Mulange. We had our sandwiches in the charcoal field. Back in the village, I slept under a mosquito net where I sustained 14 mosquito bites on my fingers b/c they were at the net's edge.

    We did many things that you should supposedly avoid in Africa. We drank the tap and river water when our filter failed. We also savored raw vegetables, including lettuce. We even had to hitch-hike back to a main highway when the evening motola (large flatbed truck on which you can ride for a small fee) failed to show. This is normal for the Mulange volunteers, who also do not take malaria prophylaxis b/c "It's easier to just take the medication when you get sick." Also, according to them, "the water in Blantyre is very safe."

    Blantyre is really luxurious. We have warm (not hot) and cold water. The water is reliable, i.e it doesn't stop running for a few weeks every so often. We have pavement. We have stores in buildings, as opposed to wooden stands where people ply their home-grown vegetables and carvings. Most homes have electricity. Some people have their own cars. People are overweight and wear shoes.

    I am now back to my on-call everyday schedule.
    Hope all is well over there.




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