Adam Hill’s Blog » Africa
Hello! This is the collection of writings from my trip to Africa in 2008. I visited Tanzania to climb Kilimanjaro, then spent six weeks in Malawi working at an eye hospital as part of an internship for optometry school. Everything that follows is in chronological order.
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The blog entries I wrote are presented below in chronological order. You're welcome to comment on anything specific, or feel free to contact me. Enjoy!
In this modern day and age, I suspect flying isn’t really supposed to be part of the adventure of your traveling so much as it is a way to get where you’re going. Oh, if only that were the case!
Our flight schedule started in Toronto. My carry-on got put through the fancy x-ray thing a few times, but they were okay with it. I thought for sure they’d want it opened — my optometry equipment doesn’t really look like anything a normal person would need on a plane — but apparently they aren’t as paranoid as they pretend to be. We had an overnight flight to London (England, obviously), where we had to switch terminals. They have this little shuttle bus that takes you around, but it’s a little unnerving when you’re half-awake and driving on the “wrong” side of the road! Heathrow decided to scan my carry-on a few times as well, then asked me to step aside… they wanted to do some liquid tests! Of everything I had with me, the hand sanitizer was the most suspect? Nothing happened on their little litmus test thing, so we were free to go wait for our flight, which was in six or eight hours. Naturally we had to eat, so we stopped in the airport and got fish and chips with tea, which I feel is a fairly stereotypical English thing!
The next flight was to Nairobi, Kenya, via Kenya Airlines. They call themselves “The Pride of Africa”, which is probably true, at least as far as airlines go. We had a big, clean, new plane, and everything was African-themed — they even had tribal music playing as we boarded! Which is why it surprised me that we were sitting around doing nothing on the tarmac for a while… until I noticed there was a giant lineup of planes. Now, I know Heathrow’s a really busy airport, but it turns out that wasn’t the problem — there was a plane on fire! I caught a couple pictures of it as we were zooming by taking off. This was another overnight flight, so I could see what the world looks like at night. Europe is, not surprisingly, fairly bright: Paris was easy to see, as was the coast of Italy. Africa, however, is incredibly dark. There was one bright, straight line at one of Sudan’s borders, but other than that it was pitch black. Nairobi’s airport, which I believe is one of the largest African airports, is surprisingly small — maybe the size of Edmonton-ish? Not something you’d expect to serve a whole continent! It’s also incredibly crowded, and full of duty-free shops and bars. We had about an hour and a half to switch planes, check on our luggage, and get on the new plane for our flight to Kilimanjaro airport. We asked directions, and went to the counter for flight transfers to get our boarding passes. After waiting in line, they told us we had to go to the Kenya Airlines counter, so we did that and waited in another line. Apparently you’re supposed to get your boarding pass not from the airline providing that flight, but from the airline you get off? Anyway, they told us to go to Gate Whatever and to hurry because our plane was already boarding. So we rush and see a giant line at that gate. Suddenly, someone yells out “Anyone going to Kilimanjaro?” and we discover that most of the line is waiting for a different flight at the same gate. After some confusion with our boarding pass — go figure, Kenya Airlines doesn’t know all the idiosyncrasies that Precision Air wants filled out — we get rushed through security, sent down to the pavement, and told “see that lady in red? Yeah, follow her… run!” Turns out that “Gate 4″ isn’t really a gate so much as an area of the airport; Gate 4 may have nine different planes outside, so it’s kind of a gamble to get the right one on time.
We managed anyways, to be in the right place in time for the plane to take off — we weren’t even the last ones! This last flight to Tanzania was a short one, under an hour, but they still tried to give us a drink service and everything. The plane ride was more what I was expecting — an older plane, with a broken seat (my seat back didn’t lock, so it could bend from laying down straight back to leaning forward at an acute angle… I moved to the window seat beside), missing safety information, etc. I was really surprised when we landed and the runway was paved! The Kilimanjaro airport seemed to be in the middle of nowhere, which (as it turned out) it kind of is, but it’s still pretty nice. It’s tiny — more like the size of, oh, my high school gym (at least the arrivals area is). You go in, get your visa (probably the worst picture ever, which is now stuck permanently in my passport!), then go get your luggage. I’d like to add that, going into the USA and getting my B1 visa for my internship in Baltimore was kind of a hassle — the guy didn’t seem to want to let us in. In the end, I got a little crappy cardboard insert stapled to my passport. Tanzania, on the other hand, seems to not care, so long as you can pay the visa fee (in US dollars only, no Tanzanian shillings!) and they give you this beautiful thing with your picture and a hologram and a giraffe… stupid USA. Anyway, we got all our luggage — surprising, because it was technically over the weight limit for the (half-empty) flight — and met our driver to get to the hotel.
The saga continues next time with the first part of the trip up Mount Kilimanjaro.
We woke up early in the morning to grab breakfast and get our bags ready. Our guide, Steven, had been very specific in his instructions to be ready no later than 8am. This seemed odd, because from everything I’ve heard Africa doesn’t tend to run on time. True to form, our guide showed up at 8:30, but we still had to wait for the vehicle to drive us there. The route we’d chosen to take, called the Rongai route, starts from the north side of the mountain, close to the border with Kenya, so we basically had to drive around the mountain, which was supposed to take three hours or so. Around 9am we get rolling, stopping twice in the next hour. First we picked up a group of porters and such from the office downtown, then again by the close (south) side of Kilimanjaro National Park to get some documents. We got out to stretch our legs here, and a guy with a chameleon on a stick came over and started talking to us! The chameleon (”kyunga”, in Swahili) was also very friendly, crawling on our hands and changing colour. They were joking it couldn’t turn white! He gave us the same advice everyone does — “If you go pole pole, you will reach the top.” Pole (pronounced as polé) is the Swahili word for slowly; for some unknown reason, “pole pole” seems to be the unofficial motto of Kilimanjaro.
So we eventually get back to driving. In Tanzania they drive on the left (unlike Canada, like the UK)… at least, most of the time they do. If the road is bumpy on the left, or they need to pass someone, or there’s nobody around and they want to drive next to someone else, or they otherwise feel like it, then they drive on the right. And another thing — turn signals aren’t just used to indicate turning, they’re also used to indicate if you want someone to pass you on that side. It’s a little unnerving, to say the least. We stopped once for a “pee break”, as the driver put it, then again for lunch. By this point, our “three hour” drive had been closer to 4 or 5. Finally we reach the Rongai gate, wait for paperwork to be completed, then start our hike. We went for a couple hours, through the “rainforest” and into the “moorland” (whatever that means). It was mostly uphill (no surprise there), and we reached our campsite before dark. Our elevation was high enough that we didn’t have to worry about mosquitoes — apparently they don’t like to live over 2500m (above sea level), and we were at 2700m the first night. The cook prepared dinner for us, which we ate in our little tiny “mess tent” — if it wasn’t for the table and chairs, we might have both fit inside! It’s funny how time works near the equator: sunrise is around 6-6:30am, and sunset is 6-6:30pm, so by the time we’re done dinner, it’s dark, we’re tired, and we go to bed!
I woke up nice and early — around 5am — not feeling well. I debated getting up to use the bathroom (cold and dark are not good motivators!) before my stomach decided for me. I got about a metre outside of the tent before throwing up all over a little bush. I’m pretty sure I haven’t thrown up since I was about twelve; obviously, it’s not a good feeling. I didn’t think altitude sickness should kick in at that low of an altitude. (Most airplanes are pressurized to the equivalent of 7000-8000ft, which is about the same height as we were camping at.) Not to mention, I was taking my altitude pills — Diamox, or acetazolamide. (Incidentally, there is a small group of arrogant Californians on the mountain now who may be taking acetaminophen (Tylenol) instead of acetazolamide…. idiots.) After falling back asleep for a couple hours, I felt a lot better. I’m pretty sure it was something I ate, except I don’t know what — looking back, we’ve eaten everything again since… oh well. There was a park ranger wandering around with a massive gun while we were eating breakfast, and he spoke to our guide. We were scheduled to hike for a few hours to a place called the Second Cave. (Yes, it’s past the First Cave, but before the Third Cave. Tanzanians are as creative as naming things as we are!) Apparently, some buffalo had gone ahead and drank most of the water there (and “spoiled” the rest… use your imagination) so we couldn’t camp there; instead, we had to plan to hike a little further to the next site. Frankly, it still wasn’t too long a day of hiking, but we went up to 3700m, which was a little harder on the acclimatization end of things. We’d specifically chosen a 7-day trek (rather than the more typical 6, or the very-rushed 5-day) so that we’d have more time to get used to the altitude — living near sea level in Canada, and then literally at sea level in Baltimore, we know we’re at much more of a disadvantage that those from, say, Denver! We started off hiking pole pole, but then somewhere along the way, one of the porters passing us started talking to our guide. The porters are staff who basically carry things — once you leave in the morning, the porters disassemble the camp, carry everything ahead on the path (passing you on the way), then set up camp and start cooking so it’s all ready by the time you arrive. They all have tricks of how to carry insane amounts of weight — usually balancing things on their head, neck, and/or shoulders — and they go at record speeds down the trails. The porter slowed down a bit, but then our guide sped up, and we were basically walking at porter-speed (read: faster than any sane person would go!) for the last couple km!
Steven came to tell us this morning that we’re a full day ahead of schedule because of the buffalo thing. He seemed pretty sure that he could change our itinerary without any problems, but his explanation of the revised schedule was too confusing for us to understand. We made a short trek over some steep rocky trails to the base of Mawenze peak, the second-tallest peak of Kilimanjaro. Climbing Mawenze involves “technical climbing” — carabiners and ropes and pickaxes and whatever — whereas climbing Uhuru, the tallest peak, is basically hikeable. It’s funny, but as you go up, there’s a definite difference in the size of the plants and things — the higher you get, the smaller everything gets. Unfortunately, this also means that there’s more dust to blow around… we’re already fairly dirty, but now blowing your noses or picking the gunk out of the corner of your eye gives you black goo. We’re also noticeably above the clouds now — at least the yucky foggy ones — as we camp around 4000m or so.
Another long-ish hike, this time through the “desert” — dry but cold, and full of rocks and dust instead of sand — between the two peaks. It’s incredibly windy — even with a toque on, my ears hurt by the time we’re done. We reach Kibo, which is the “base camp”, so to speak, of Uhuru peak — all the routes converge here at the hut. It’s busier than our other camps have been because of this, but still not overly crowded. Because of our schedule change, we’re also here with our friends from the hotel, who had scheduled the 6-day climb, as well as us and the other 7-day people. And because of the wind, our eating tent is gone. (It either broke or lost a piece, nobody’s really sure.) In any case, we’re now squeezed into our own tent to eat our meals. Kibo is high — 4700m — and doesn’t have its own water supply, so we and our porters had to bring what we needed for the next couple days. Because of this, we decide that there’s no sense in waiting around to acclimatize further, as our schedule had initially called for; rather, we’re going to head for the summit at midnight.
This leads to another interesting point — English. It’s not the country’s official language, but those who can speak it tend to have better jobs, and most of the schools seem to be teaching it. That being said, there are lots of things that don’t quite make it across in translation. Telling time — time already being a ‘weak point’ in Africa — is one of these. Our guide says we’ll be starting to summit at midnight. We ask if this means we wake up at midnight, or we’re leaving at midnight. “Yes”, is the answer. “What time are we leaving?” “12:30.” “So what time do we get up?” “5:30.” *confused look* “No… what time should we wake up?” “5:30!”… “When will the waiter wake us up?” “Oh…. 11:30.” Once we’ve got this sorted out, we’re off to bed (at, like, 3pm) to sleep until we summit.
This is the short version:
And this is the long one:
The waiter wakes us up. This has been the plan all along for the mornings, but we’ve always been up before we needed to be, so he’s never actually come to the tent to wake us up. It goes something like this.
“Yeah, summit, we’re awake”
And he walks off. Most of our encounters are like this, except at dinner there’s usually more Swahili involved. And not the “yes, no, please, thanks”-Swahili that we know; we’re talking full-blown tornado-speed Swahili here. He’s very friendly, but his English could use some work. We know he’s teaching himself by reading labels, because he called the honey “miel” on the first night!
Anyhow, we get ourselves bundled up — it’s freezing cold down here already, and we’re hiking up to a glacier on the top of a mountain. Double layers of pants, three shirts, warm jacket, thick socks… We’ve also got little battery-powered headlamps, because it’s midnight and dark. Fortunately, we’ve got a full moon — for us it’s a coincidence, although apparently some others in our group had picked this week for that reason — so we don’t really need the lamps until the moon goes down. It’s a long hike, punctuated by very short (2-minute) breaks. Little do we know, but Steven has decided that we need to be at a certain spot at a certain time to watch the sunrise, so as we go along, we aren’t going pole pole anymore! The first part of the trail is fairly ordinary — just switchbacks over the steep incline, and it’s a pretty well-worn trail. The last quarter or so, though, is all over rocks, and we’re pretty sure Steven is just trying to make up a path as we go along! We scramble up to Gilman’s Point to watch as the sun rises over Mawenze peak.
We run into a few people we know there, most of whom arrived before us (because most groups left 11:30 or 12:00, not 12:30), and take a quick break before heading up the final 300m or so. (That’s 300m vertical; it’s probably an hour’s walk or so.) We walk around the crater rim — Kilimanjaro’s a volcano, although it’s been dormant for ages — and we seem to be taking some little back pathways to try and beat the mad rush of people to the very top. Uhuru is the tallest point on Kilimanjaro — actually, the tallest point in Africa — and everybody takes a picture in front of the big sign. It’s actually so old that if you lean on it too hard, it’ll lean right over! We get there, and manage to butt in line by befriending another group ahead of us. (We offer to take pictures of their whole group, guides and everyone, and they do the same for us. Turns out they’re Canadian too!) We look around for a few minutes, seeing the glacier beside and below us — if you’ve seen An Inconvenient Truth, you’ll know it’s shrunk a whole bunch over the last however many years or something — and the edge of the volcanic part is (black rock vs regular rock), but then it’s time to go back down. As Mark’s travel doctor put it: “You’re so high that no life can survive. Nothing. You don’t want to stay up there any longer than you have to!” With these words in our head, we pass the lone permanent resident: a chipmunk, the only form of life that does actually survive up there. All the guides know him; apparently he just eats scraps and nobody knows how he survives the low oxygen.
We start off going down the same approximate trail we came up. Mark starts having some problems — his legs wouldn’t cooperate with his brain — so the guides decide it’s some variant of altitude sickness that only happens on the way down, and we rush down the mountain in a more direct route. (You can safely go down in a straight line, but if you were to go up in the same straight line you’d find it too steep, and if you slip you’re screwed.) After a few hours rest back at Kibo, we head down the Marangu route towards Horumbo to get to lower altitude, where we’ll spend the night.
The Marangu route is listed on all the maps as the “tourist route”. It seems to be the most direct route, but it’s also the busiest and the most built-up. It’s the only one with permanent little huts and things, the bathrooms have running water…. it’s known as the Coca-Cola route. We deliberately chose not to go up that way, but most of the routes go down this way, simply because it’s easier and closer to where the hotels are. Our campsites have always been a little group of tents, maybe twenty or thirty, with the only permanent buildings being outhouses, many of which were lacking fundamentals like doors or locks. Horumbo is like a village, with twenty or thirty buildings — there’s one for a ranger, there’s eating huts and sleeping huts and washrooms and all sort of things. There’s also room on the side for us to camp in our tent, which is what we do. After such a long day, we fall asleep quickly.
We wake up early to the waiter’s shouts again. In such a city of tents, it’s hard to figure out who’s yelling “hello” to whom — apparently that’s the only way that anyone wakes anyone up here. We get an early start down the trail towards the gate, stopping at Mandara for lunch. Since it’s not busy, we get to actually eat in one of the huts — it’s quite nice! By this time, we’re back down in the rainforest, which is much nicer on this trail than the Rongai side. While we’re eating, we’re interrupted by one of the guides yelling “Monkey!”, so we all go outside and see the monkeys playing in the trees beside the hut and having a lunch of their own. A couple more hours down the trail and we’re at the main gate, ready to sign our papers, get our official certificates, and head back to the hotel.
In the interests of getting rid of some of my “accidental souvenirs”, as it were, I’m having a little contest. I’ve got a half-dozen small prizes from my trip up Mount Kilimanjaro, and if you’d like to have one as a lucky charm, you’re going to have to win it! They’re real prizes — not something stupid like rocks from my shoe — but they’re also not super-amazing, like your own private porter, so go crazy, but not too crazy.
Here’s the deal — answer as many of these as you can, either in a comment or an email, and I’ll let you know if you win and how to collect your prize.
1. What country is Mount Kilimanjaro in? (Hint: Africa is not a country!)
2. How tall is it?
3. At what altitude did I meet someone who knew where Whitby was?
4. Name a Swahili word or phrase that’s made it into common English vocabulary.
5. What colour did the chameleon turn when it was crawling on me? Why?
6. “Poa chizi kama ____” — Kilimanjaro is cool and crazy like a ______. (Fill in the blank; your answer is likely to make more sense than the Swahili saying!)
As you can see, the answers to some of these are easily found in my blog, while others can’t be answered with any amount of research, so just make up something reasonable and funny when necessary. I’ll post correct (and winning) answers eventually.
Well, we arrived in Malawi yesterday. (Note: I wrote this a while back but didn’t have web access; we’ve been here since the 23rd.) Luckily, we didn’t have any issues with our luggage — it arrived with us, and nobody complained about us having too much (which I believe we technically did). Customs was okay with us too, thanks to our letter from Dr. Kalua, our supervisor here. In fact, they seemed confused — I think the lady’s exact words were “okay, well you have a letter, I guess you can go!” We were met at the airport, then driven to the hospital to pick someone up, then we picked up Dr. Kalua at a gas station. (I’m still not sure why!) We went to the only mall in Blantyre to have lunch, then we were dropped off at the house to settle in.
I have to admit, my first impression of Malawi (or at least Blantyre) is that it’s a lot nicer than Tanzania was! The roads are in much better condition, there are newer and nicer vehicles on the road, and even the small businesses and things on the side of the road seem better kept. Admittedly, we’re in the big commercial center of Malawi, compared to a relatively small town in Tanzania, but still, we haven’t seen anything too shocking yet.
I feel as if we aren’t living where Lisa and Richard were last year. I figure one of them would have mentioned something about sharing a room, or living with a family, or having a cow and chickens in the backyard! We live with a physician from the hospital, his wife, and two sons. (Although one of them goes back to boarding school in a week….) There’s the “backyard” part of the yard, with a trampoline and such, and then there’s the “farm” part of the backyard, with Jenny (the cow), some chickens, goats, fish in a pond, dogs, and plants — the crops seem to have been harvested recently, so I have no idea what they grow. The house is walled and gated, like all the houses in the neighbourhood are, for security reasons.
The hospital, in our brief stop there, seemed nice enough. It’s a lot larger than I’d thought! There’s buildings and wards for all sorts of things — maternity, ophthalmology, etc — and a lot of green spaces in the middle. We’re getting our actual tour of the place today, but I suspect it won’t be until we’ve actually been working there a little bit that we’ll really get a feel for how it works.
The people here so far have been pretty friendly, and their English has generally been better than in Tanzania, so that’s a good sign for the future too! I’m sure I’ll have more to write later, but that’s it for now.
So it turns out we definitely aren’t living where Lisa and Richard were last year. Since Dr Kalua is gone to a conference in Argentina for our first week, he didn’t want us living on our own at the guest house, so we’re staying with the random host family at least until he’s back. Hopefully they let us stay when he returns — the food is much better (the mum is a chef) and it’s nice having people to stay with. They’re taking us up to Zomba this weekend because they have a wedding to go to, so we get to see more of the country. Dr Kalua’s back today, supposedly, so we’ll see what happens.
The hospital is much less exciting than we’d hoped, so far. I think part of it is that somebody else here basically got “stuck” with us for the week, and they seem less than thrilled with the idea. So far, we’ve spent most of our time sitting in the library and waiting for something to do, and reading the ridiculous books that are in the library. I’ve gone through one about heart bypass surgery, one about blind children and how they develop, and a guide to the care and feeding of children from 1914. It details such important things as what kind of milk to give kids (not from Jersey cows; that’s too rich), what to do when they’ve having seizures (immobilize them and wrap them in mustard), and how to cure conjunctivitis (boric acid). We have yet to be shown around the hospital or introduced to people, which was on the schedule for the first morning.
The first day it only took about three hours for them to come find us. We ended up watching some surgeries. Although we were told that Dr Kalua was the only ophthalmologist in the country, it turns out there are three now. As it happens, all three are out of the country this week (India, Tanzania, and Argentina), but the simple surgeries are delegated to ophthalmic medical assistants or whatever they call themselves here. “Simple”, in this case, means anything where vision or the eye won’t be affected — so removing conjunctival tumours (which are on the surface), or removing eyeballs that are completely blind. The enucleation (eye removal) was like something out of a horror movie — he actually dropped the severed eyeball so it rolled down the patient’s forehead and almost dropped to the floor! After this, it was time for lunch. Two hours later, we went looking for anybody to tell us what to do, but there were no patients, so we just sat around until it was time to go.
The second day we were going even more stir-crazy — it took until almost 3pm for them to get us! (We start, officially, at 7am, so that’s 8h of being bored in the library.) We’re supposed to have an internet connection here, but all three ports in the library are broken. We wander down the hall to the lecture room, where the connection does actually work. When we’re called, we get to sit in on the assistant doing some partial eye exams. Most of it is pretty basic stuff, like allergic conjunctivitis, although we’ve seen a couple foreign bodies too. Apparently nobody has told him where we are in our education — he asks us if we’ve used a slit lamp before! (This is something we learned in our first term of school, before we even got into the preclinic.)
The third day, we were definitely running on Malawi time — they didn’t get us until about 3:30! We also learned that “I’m coming” means that they might eventually come, in an hour or two, and “I’ll be there in five minutes” means approximately three hours. We’re back to observing eye exams, and today we have the benefit of a couple screaming children. Kids seem terrified of us — it seems doctors are bad enough, but white doctors are just plain scary. To top it all off, we’re kept late because there are too many patients! It seems to me that, rather than keeping us qualified people around doing nothing, we could have helped to alleviate the mad rush of patients, right?
So today, we’re hoping Dr Kalua comes back and gives us something productive to do!
On a side note, I’ve got a cellphone here, so if you feel like talking or texting, the number’s on my Facebook page. Keep in mind it’s an international call (country code 265) and a 6-hour time difference from EST!
So for anyone who hasn’t realized by now, our Internet access here is sporadic at best. As a result, I won’t likely be posting any photos until I’m back in Canada, probably around the second week of October or so. Rest assured there are lots of photos — Mark and I together have taken over a thousand so far — but you won’t see them until I’m back, unless (like Kilimanjaro) they represent some form of awesome achievement. If you have specific photo requests — I’ve had people ask for giraffes, monkeys, and “any cute young animal” — let me know now.
The lack of technology has been interesting, one might say. I’m not talking about the Internet — I wasn’t expecting much from that end of things. But basic things, like electricity, plumbing, washing machines… very little here is as reliable as I’m used to back home. Where we are, we get rotating blackouts — “load sharing”, they call it — for about an hour every other day. This has been going on as a ‘temporary measure’, we’re told, for three or four years. On a good day, the water in our bathtub is more than a trickle; on a bad day, the house has no real functioning water inside. (There’s a well and a pump outside.) And yesterday, when we tried to do laundry, we realized the washer takes about two and a half hours to do its thing with one load — and it’s a tiny front-loading machine that takes about half a Canadian load of laundry! Nevertheless, other things that seem a lot more complex — like the health care system, or traffic and construction, public transport — work a lot better than you’d think just from looking at it. I guess it’s just a matter of getting used to things here. I think the plumbing is probably the most irritating, because usually I don’t realize there’s no water (or no hot water) until I’ve got my mind set on having a bath.
I’ll have to post about our weekend later, because it’s a lot to write down, but in short, we went to what I think was a National Park near Blantyre, and to another conservation area about 70km from the city. Lots of stories and such — too much to write now during my lunch break — but I’ll post when I can.
We had a chance to see some of Malawi’s “natural side” this weekend, which was nice.
Actually, that’s not entirely true. First, on Friday, we were taken by minibus into town to see the few interesting sights there are in Blantyre. Minibuses here are insane — the ones in Hong Kong are basically like limousines comparatively. Picture a van — like a cargo van, or the Res Life van — with thirteen seats in it, plus the driver. Then cram about twenty people in there, four per row, plus some random guy whose job is to collect money from the passengers who fits in the van however possible, whether that’s sitting on someone or crouching at their feet or hanging halfway out the window. I knew it would be an interesting ride when the guy said he had room for one, but since we were three we could squeeze in! Later — we had to transfer minibuses — I had a bit of a Borat moment. You know that scene where there’s a chicken on the subway? Yeah, well, we had a live chicken on the minibus… except that it looked and behaved dead for the first half of the ride, so until it started freaking out halfway, nobody else realized that there was a chicken on board! (Except me, because I was sitting beside the guy… we both looked down and just laughed at the general confusion.) In addition to the tons of people, we also had all their cargo, whether that was live poultry, fifty pounds of charcoal, or several cartons of eggs (which, miraculously, escaped intact.) Oh, and somewhere in between I managed to knock the sliding door clean off its tracks while getting in. Talk about adventure! Once we got to the downtown part, we saw the big famous church and some historical buildings, which we visited quickly, then met up with our ‘host mom’ and went to a nearby forest reserve.
Okay, now for the nature stuff. Blantyre has a few ‘mountains’ around it, each of which is surrounded by forest reserves with hiking trails, animals, birdwatching, and so on. We went to Mount Michiru, and walked around for a couple hours with our ‘guide’. The way it works is, there’s no real gate, fence, or boundary to the forest reserve, so they depend on their forest rangers to stop people from coming in, cutting down trees, and selling the wood. While they’re wandering around protecting the forest, they’ll bring people along with them for a few extra bucks — it’s not in their job description, but since they have to walk around anyways, they give informal tours. We headed up for the top of the ‘mountain’ (really a big hill; it’s 1473m), and he said we’d go down slower and look for animals and stuff. We did see a couple interesting birds on the way up, but since I don’t know anything about birds, it wasn’t that exciting. At the top, we sat down and chatted for a while, just enjoying the fresh air and scenery. Our guide was a bit of a character, and he seems to have lots of crazy theories about animals (which ones are ’shy’) and differences between the northern and southern hemispheres and how the Coriolis effect applies to everything from water to snakes to people. I saw a giant baboon going down one of the paths in the distance, too.
On our way down, we noticed a lot of areas that looked like they’d been burned. The guide said that the wood-poachers (or whatever you want to call them) burn down the grasses and things so they can see the forest rangers coming, before they get arrested. Further down, one of these fires was still going. Usually they behave like a controlled burn, but this particular one was a little bit too close to the little ranger hut lookout thing and had managed to set its ladder and support posts on fire. Our guide grabbed a giant stick and tried to fight the fire with it — surprisingly, this did not work well. We carried on, heading down a couple paths that usually had hyenas and bushbucks and stuff, but all the animals were scared off from the smoke and flames, so we didn’t see anything until there were a couple more baboons by the parking lot at the very end. It was a nice nature walk, to see different trees and birds and things, and seeing a man fight a fire with a stick made it all worthwhile.
On Saturday, we went with our host family to Zomba, about 70km north of where we’re staying. They had a wedding to go to, but they said they could drop us off and let us wander around, then pick us up later. This plan later got refined to “I know somebody who can be a guide for you so you don’t get completely lost.” (This may or may not have helped, but anyway…) Zomba’s a town that used to be the capital of Malawi, and it’s right beside this big mountain-type thing called the Zomba Plateau. It’s another one of Malawi’s famous nature reserve places.
We started off early in the morning, and had a fairly easy drive. We were dropped off at the big hotel at the top of the plateau. Despite the fact that we already had a guide with us, this random guy from the hotel insisted on giving us the grand tour of the hotel, so we agreed. This ended up being a good thing — there were a bunch of monkeys up in the trees outside the restaurant, maybe ten feet away from us, so we got some awesome pictures. After seeing the entire hotel, including things like conference rooms that we clearly would never need, we were set free walking down the road. After a little while, we ran into some guy loading wood onto a bicycle who told us that there was a shortcut off to the one side. Well, I suppose on the map it was a shortcut, but it was basically a giant steep hill with very little shade and no flat spots to even take a break. By the time we got to the top, it seems we’d taken as long as we would have on the real path. Anyway, the first stop was at Chingwe’s Hole. It’s a giant hole in the ground – which sounds stupid, except that you’re at the top of the plateau with a great view of the city and surroundings and such, and then there’s a giant (10m diameter) random hole in the ground that drops down something like 2000 feet! They used to throw the corpses of lepers (or sometimes live lepers) down there so that nobody else in the villages would catch the disease. Yay!
On the way down from the lookout point, we took the real path, and it took about as long as it did to go up. We got to the Trout Farm, which had an entrance fee of something like $1. They’re not just a fish farm, though (although that is part of the tour). No no, they also have a restaurant, canoe rides, picnic area, and little cabin things where you can stay. Keeping with the theme from earlier, we also had to have the full tour of everything (even going into a cabin!) despite telling them we just want lunch. There was no trout or fish of any kind on the menu, so we settled for chicken burgers. They turned out surprisingly beefy!
Back on the path after relaxing a bit, we stopped at Williams Falls, which is (not surprisingly) a series of waterfalls. It was very pretty, and we ran into a giant group of random tourists. At least, I assume they were tourists — most of them were either white or Asian. Up the stream a little bit was a little place where you can fill up your water bottle with fresh mountain water… so we did. (Take that, travel doctor!) We continued on up to the last lookout point, called Queen’s View, and saw the sights from there. After a while, seeing different views of a strange city gets kind of boring — at least in Toronto or Baltimore or whereever, I know what I’m looking at.
It was getting towards the end of the day (we’d said we’d meet back at the hotel around 4-5pm) so we started heading back. Our guide told us that we’re approaching the dam. Now, we’d driven past a giant dam, and seen it off in the distance while we were walking, so we were very excited. It turned out to be a different dam, a little tiny one, but there was another random guy who told us of another shortcut. It was on our map, so with a little description from this dude, we were on our way down another shortcut.
Well, apparently shortcuts work on “Malawi time”, too. This one led us along the main road for a bit, then onto a footpath a bit further along. The further we went, though, the less and less obvious the path was. Our guide said he’d never taken the path before and that maybe it grew over during the last rainy season, but we could see the giant dam (and hence knew where the hotel was) so we kept heading that direction. Until the trail disappeared completely, that is. At the beginning it was a regular footpath, then a couple hundred meters later it was very very narrow, and then nothing. The forest wasn’t too grown over, so we could make our own path through most of it. It started as walking along the ground and cutting between bushes, then turned into climbing along logs over scary-looking drops. (Probably no more than ten or fifteen feet, but still.) Twice we hit what were basically twenty-foot precipices… the first one, we went down slowly and carefully; the second one, we turned and continued making our own path in a different direction. After being thoroughly lost in the bush on our “shortcut” for the better part of an hour, we reached what looked like a recently-trodden path, which we followed. It turned into a road!
We figured if we followed it, it would take us to one of the main roads. Oh, how wrong we were! The road (which started at some random path) ended up at the giant dam — but not at the top, where you could cross to the hotel. No, it ended at the bottom! Somehow, we’d managed to go all the way down to the bottom of the dam. Luckily, there was another footpath (a real one, not one our guide made up on the fly) that led to the main road fairly quickly. We called our host family (who had called us a half-dozen times wondering where we were… they weren’t impressed when the guide didn’t have a real answer), who picked us up quickly. As a souvenir of our crazy harrowing experience, we each kept a piece of our walking sticks… and took photos of each other looking frustrated. We were very glad to get home!
In conclusion, we’ve now had the real African bush experience, and seen a part of Malawi that nobody (even sane Malawians!) have ever seen. And, if a Malawian ever offers a shortcut, make sure he’s done it before!
Well, our first real week here is done, and it was a real improvement over the first week without Dr Kalua. Every morning he comes for us and gives us a quick lecture (30min or so) on a topic that’s of relevance to health care in a developing country like Malawi. So far it’s mostly been the “big stuff”, the things that are on the WHO’s list of leading causes of preventable blindness worldwide. That includes refractive error, cataracts, vitamin A deficiency / xerophthalmia, trachoma, onchocerciasis, and childhood blindness. We’ve also been talking a fair bit about the “Vision 2020″ program, which aims to eliminate preventable and avoidable causes of blindness worldwide by the year 2020.
After that, we go to “handover”, which seems like it should have a Canadian equivalent but I can’t think of what it might be. Basically, the night nurse goes over what happened the day before with everyone who will be there during the day — how many people admitted and for what, how many discharged, anybody with complications, etc. Usually we end up going to one of the wards to check on the patients immediately afterwards. This is, as Mark puts it, as if somebody lined up a textbook and asked it to walk in, one condition at a time, through the ward. We’ve seen a whole ton of rare conditions and tumours and things here, and it’s only been a week! Rhabdomyosarcoma (at least two or three), retinoblastoma, a whole ton of squamous cell carcinomas, people with bilateral cataracts to the point they’re only seeing light perception, end-stage glaucoma and optic atrophy… it’s pretty crazy.
We’ve been able to observe some more surgeries. They don’t do phaco here; rather, it’s the ECCE (extra-capsular cataract extraction) that’s done routinely, with non-foldable IOL implants. We’ve also done a couple examinations of kids under general anaesthesia; I feel like this doesn’t happen often in Canada, but when you’ve got a squirming screaming kid who you think might have a tumour, it’s something that needs doing, I suppose. (For a lot of people, “come back next week” isn’t exactly an option either; the hospital here draws from a population of almost 6 million people, many of whom have to travel a couple hundred kilometers to be seen.) Malawi’s health care is free, including travel costs for those who can’t afford it, but that also means that things happen on a different schedule here — there’s probably half a dozen patients in the ward who’ve been there for a few days just because they’re waiting to get a CT scan done.
On Friday, we had a break in the routine. Dr Kalua calls himself a “community ophthalmologist” (rather than “clinical” or “research” or “teaching” or all the other things he does), so we went with him on one of his community projects to a place maybe 50km south of here called Mulanje. The largest mountain in Central Africa is there (called, unsurprisingly, Mt Mulanje), and aside from a fairly small ‘downtown’, it’s a pretty rural area. The project there involves trying to identify children who may be blind, then getting them seen at the hospital. Now, it would take forever for Dr Kalua or anyone else from the hospital to go around hundreds of square kilometers of rural area to track down kids, so instead, they’re training community people — pastors, teachers, even traditional medicine healers — to identify the signs of common causes of blindness, and they’ll check back in a couple weeks with them to see how many children they’ve found. Now, since the whole training thing was in Chichewa, we didn’t really know what was going on until the drive home, but it was still interesting to see what they do outside the hospital.
Anyway, at the rate we’re going, we’ll probably see a whole ton of interesting pathology by the time we’re done — we’re allowed to take photos, so maybe we can write our own textbook!
We had a quiet weekend here, especially compared to last week’s adventures! The family is all gone — one to the USA, two to Lilongwe — so we had the place to ourselves, for the most part.
Friday afternoon we went to the market in town — we’d heard it had just about everything, and it looked fairly huge from driving by it every day on the way home from the hospital. After a short and painless minibus ride to town — the minibus was almost empty — we started exploring. The market was much bigger than it initially looked — the stalls continued down and across a little creek, so the whole thing took up basically a full block. There were stalls selling all sorts of stuff, from toiletries to clothing to used books to hardware to cellphone accessories. Up the hill was a huge building with all the food vendors inside — fruits, vegetables, meat (including the ever-popular live chickens… as well as less squirmy meat) and so on. We didn’t end up buying anything, mostly because we don’t need food or clothes, and nobody was selling anything even remotely artsy or touristy. I suppose it’s because the market is meant for the people who actually live here, but still… I would’ve expected at least one or two vendors to have some little elephant sculptures or something. We’ll have to ask the locals or else we risk going home with no souvenirs.
The other two days, Saturday and Sunday, we essentially did nothing. Laundry and that sort of thing, but nothing special. I think the most exciting thing was on Sunday afternoon, Mark came rushing into the bedroom saying there was a hurt goat outside. My response was “we have goats?” I hadn’t been aware of this — we see the cows, chickens, and dogs all the time, and the cat periodically, but no goats. There were three goats tethered in the back corner of the yard, which is on a bit of a hill. Two of them were tied to ropes which were staked down on the flat part, at the bottom of the hill; the third goat’s stake was in the middle of the hill. Of course, it had managed to get its leg tangled in the rope, fallen down, and slid as far down as it could, pulling the rope tight and eliminating any chance that it could get up on its own. At first the goat seemed confused as to why I was trying to lift it; eventually it figured it out and started cooperating. It had managed to get the rope (tied to its right front leg) wrapped around its left hind leg, which had somehow gotten crossed over its back right leg. It took a few minutes, and the goat resigned itself to being stuck more than once, but we got things untangled and got it back up. (Now, it was still stuck on the awkward slope of the hill, but at least it was upright.)
Now, if you’re anything like us, you’ve got a few questions at this point. For starters, who stuck the goat on the hill? And where did that person go? There’s usually a few staff around (the family we live with has a couple servants, some of whom seem to be responsible only for the animals), but nobody was anywhere to be found. Even the people who usually cook and clean seemed to be taking it easy since “the boss” was away. On the plus side, I now get to add “goat rescuer” to my resume!
Well, we just finished our third week here at the hospital in Blantyre, which means that we’re halfway done our rotation in Malawi. Unlike my work in China last summer, I feel like I’ve been here long enough to understand the system and what’s going on, and I’m actually making a difference and helping out here more than I am getting in the way! It’s good to think there’s another three weeks where, rather than having to try and figure out the routine and protocol for things, I can just see patients all day.
Last week was surprisingly un-routine. Monday was, as usual, incredibly busy — usually over the weekend, a bunch of patients are admitted, plus anyone who’s had a not-so-serious problem over the weekend shows up at 6 or 7am on Monday morning. Tuesday, we observed surgeries again — mostly cataracts, but a couple corneal repairs (after perforating injuries) and a couple kids under anaesthesia as well. In true Malawian style, the electricity went out partway through, causing the person under general anaesthesia to wake up (the ventillator only had enough battery power for a minute or so). Fortunately, his surgery was almost done, so Dr Kalua quickly finished some sutures and let him go. We also had to use handheld lights to see what was going on, because the microscopes of course had no power either. After about twenty minutes, the electricity came back on. Apparently, whenever the power goes out, somebody from the hospital has to call the electric company and complain that they’ve just (inadvertently, they claim) shut off power to the hospital, at which point it’ll get turned on immediately. You’d think they could figure out which switch that was and not turn it off, though.
Wednesday was another one of our community outreach programs. We went to the nearest district hospital — district hospitals are smaller and don’t have ophthalmologists — which was about 40km away, to examine and perform cataract surgeries on a number of patients who had been ‘collected’ over the past few months there. We saw a number of ridiculously mature / hypermature / completely liquified cataracts, and chose 23 who could have the operation done there that day. The rest, plus a couple serious ones who were young (and so they needed extra measurements done) were driven to the hospital on Thursday to have it done there. Rather than watching cataract surgery for the third day in a row, on Thursday Mark and I wandered off to the outpatient clinic to make ourselves useful. We saw a whole bunch of patients — I don’t know exactly how many, but I know we ran out of patients half an hour early. Usually they stop taking people at noon, and tell anyone who’s left to come back at 2pm; we saw the last person at 11:30 and there was nobody left waiting. We also learned that, when a corneal foreign body leaves a ring of rust in the eye, they don’t use an Alger brush to remove it like we would at home; rather, they scrape the cornea with a scalpel. So, you know, if you’re going to get something in your eye, don’t do it in Malawi.
Friday was a half day, and we did ward rounds. Somehow, over the course of the week, the ward had approximately doubled the number of people staying in the hospital. Since no doctor will see them over the weekend, the goal is to discharge anyone who doesn’t need to be there, or who can be sent home with medicine. We managed to get rid of a few of the cataract patients who were doing well after surgery, as well as a couple kids, including one who screamed when you so much as look at him. (He was five, and a real wimp… he couldn’t even stand having his eyepatch removed! His mother was also carrying him around on her back like they do with babies here.)
The rest of Friday and our weekend was a bit of an adventure, but I’ll cut this short here and continue tomorrow with what happened.
Anyone who’s heard some of my stories from China might recall that there’s no word in Chinese for “optometrist”. Malawi seems to have the same problem, and because there are no optometrists as we have them, we’ve had a few confusing moments here when people either think we can do things (like surgery) that we can’t, or the other way around (like knowing what to do for allergic conjunctivitis). In any case, because Malawi has way too few eyecare professionals, they’re starting an optometry school in the north part of the country; the first class starts this year, I believe. We always have half-days on Fridays, but this week we stuck around for the afternoon because there was a big meeting that our supervisor, Dr Kalua, said we should attend — he said it was about optometry, and that we’d find it interesting.
Just to explain the system: in Malawi right now, they have ophthalmologists, “clinical officers” (both general and ophthalmic), ophthalmic nurses, and refractionists. Clinical officers seem to be half doctors, half technicians — they don’t necessarily know a lot about diagnosis, especially for complicated cases; rather, they screen out the ‘easy things’ (like allergies, infections, foreign bodies, etc) so the ophthalmologists can focus on more difficult cases and cataract surgery. The clinical officers, though, can also do simple surgeries, like tumour removal, eye removal, etc. With extra training, they can even do cataract surgery independently! (There are clinical officers for other things too, not just eyes; some clinical officers do stitches, or perform Caesarian sections!) Nurses are nurses: they look after patients in the ward, assist with surgery, give medicines, etc. Refractionists don’t seem to be so much in the medical system, but they’re basically the experts at retinoscopy and determining a prescription for glasses. The hospital has a bunch of each — I think it’s three ophthalmologists, five clinical officers (including two who technically are retired but work because there’s no one else to do their job… one of them has been doing this for 18 years!), ten or twelve nurses (it’s hard to tell, because they’re on shifts), and I think one refractionist.
Anyway, so we told the meeting would be something about the optometry training, and there was a special guest speaker who was a Pakistani optometrist. It turned out that the guest speaker was actually a UK-trained optometrist working in Kenya (although she looked Indian or Pakistani, I suppose), and the meeting was actually about one of the outreach-type programs they run. It’s called the Malawi Integrated Education Program (MIEP), and it serves to identify blind children and give them the resources to either attend special schools, or to be integrated into the school system where they already are. There were about twenty people at the meeting, ranging from ophthalmologist to clinical officer, from teachers to funding sources, and even a couple bigwigs from the Ministry of Education. (One of them, I might add, was blind himself — he seemed very passionate about his job as the director of Special Needs stuff.) In any case, it was very refreshing to hear the perspective of another optometrist, as well as just seeing someone who isn’t so single-focused on cataracts and surgery!
One thing I found surprising is that in Malawi, low vision services are provided through the Ministry of Education, not the Ministry of Health. (It kind of makes sense, because most LV things here are for kids with albinism or congenital cataracts… people don’t generally live long enough to get serious ARMD or anything. That sounds awful, but it’s true.) It was really neat seeing and hearing how they do things — they have specially-trained teachers who learn how to assess vision and use low vision devices (things like magnifying glasses and telescopes) so they can actually help the students! The leader of the meeting was very smart, very well-spoken, and was very good at calling out what the problems were in the system that are preventing the kids from getting their glasses and LV devices. (The stats show at the moment that 80% of the kids who need glasses don’t have them, and 60% of those who need a device either don’t have it or have never been shown to use it… and that’s just the kids who have already been identified and put in the MIEP program!) The meeting was actually a three-year review of how the program was going, and it seemed like there was a lot of room for improvement, to put it nicely. There are a lot of problems, but it seems like the bulk of it lies in a lack of documentation and a lack of responsibility (or accountability, I suppose) for things getting done. The guy sitting in front of me was the guy from Sight Savers International, a UK-based NGO that is funding MIEP. He was very, very upset about how the money wasn’t being used as well as it could be, and went on a long tirade to try and guilt-trip everyone into doing what they’re supposed to. After he left (early — he had a flight to catch), we found out he’s like that at every meeting he goes to… which explains why everyone in the back row was trying really hard (unsuccessfully) not to laugh. I think with a bit of extra training, and some measures to ensure that people have to actually do work with the children to get paid, that the program will continue to help blind and severely visually impaired children in Malawi.
Anyway, because this guest doctor was from Kenya, she had to fly back, but she couldn’t get a flight from the local airport, so she had to go up to the capital city. Fortunately, we (me and Mark) found this out a couple days early, and got invited to go along for the ride! More to come on our trip to Lilongwe next time.
Continuing on from last time — we went to Lilongwe, Malawi’s capital city, this past weekend. It’s 300km or so north of Blantyre, where we are — note that, in Africa, this is *not* equal to three hours! Because it takes so long, the plan was for the driver to drive up that Friday night, drop off the doctor at the airport, then stay over and drive back at some point on Saturday. Since there was that gap in between, we decided to tag along, because there would be enough of an opportunity to see the sights in the city. Lilongwe is a relatively new capital, so there isn’t actually a whole lot to do outside of seeing the government buildings and a few other things that happen to be there. (Malawi’s first president, a more-or-less dictatorial “president for life” who was democratically elected, liked to rotate the capital between three cities: Blantyre (where we live and work), Zomba (where we got lost in the wilderness with our guide), and Lilongwe. There are government buildings and official residencies and such in all three cities. For a long time Zomba was the effective capital, but when the next president was in power, in 1998, it was permanently assigned to one place, Lilongwe.
Okay, history lesson over. We left almost immediately after the meeting, and had a very nice chat with the visiting doctor. She seemed appalled at a few things that happen at the hospital — how children get cataract surgery without being put into the MIEP program at school (which should be mandatory — these kids always need glasses and almost always need help learning to use their vision properly), and how the ophthalmologists don’t believe refractive error (needing glasses) is as common in Africa as it is in other parts of the world. (By comparison, something like 90% of Asians are nearsighted and need glasses; we’ve been told in Malawi it’s closer to 1-2% of people.)
After dark, there are several police ‘checkpoints’ between cities along the main highway. We barely had to stop — a half-empty van, with a hospital logo painted on the side and a couple of white guys inside, is apparently not suspicious. All the big trucks and the minibuses had the police checking them out, counting how many people there were, etc. After a few hours, we pulled over seemingly randomly in the middle of nowhere — the driver wanted to buy some tomatoes, which were being sold on the roadside by candlelight (it’s dark here past 6:00 or so), so we stopped. I might add, those few hours on the road were filled with some of the most terrible music I’ve ever heard. It started off with ’soft rock’ on a CD — English music with Bryan Adams, Whitney Houston, etc. That wasn’t too bad. Then it turned into some old country singer drawling on about Jesus and sinning. Just when we thought it couldn’t get any worse, the same country singer was performing Christmas carols! We couldn’t believe it! Everyone else seemed to be enjoying it, so we didn’t complain, but it was pretty ridiculous. (They put the same CD in on the way back, too.) Eventually, without further interruptions, we ended up in Lilongwe, dropped off the doctor and her assistant, and found a hotel to stay at.
There are two kinds of hotels in Malawi — “hotels”, which are real hotels, and “resthouses”, which are basically the equivalent of hostels. We were at the latter, and although our room had a private bathroom, it was definitely a no-frills kind of place! There were people yelling in the halls at all hours, randomly knocking on our door at 8:00am, and a group of workers hammering on the floor right outside our door all morning until we checked out. Oh, and a random guy outside banging a long pipe around. The driver picked us up at 10, and we made the first of our stops, at the main hospital in Lilongwe. There, too, is a Lions SightFirst Eye Hospital, like the one we work at in Blantyre; a third lies in the north, in Mzuzu. Apparently we had some things to drop off, some things to pick up, and some conversations and phone calls to make — we spent about half an hour here, mostly looking around, while some of our fellow travellers from the optical shop in the Blantyre hospital did their business. (They, like us, had hitched a ride up for the day.) Next we went for lunch at some random restaurant. Outside was a bank festival…. yes, a bank festival. There were several tents set up, with balloons, flags, and hats being handed out; everything and everyone was plastered in the “Standard Bank” logo and colours. At one point after we’d ordered, a couple guys started playing drums and women started doing some form of “traditional dance” (or so we were told… to me, it looked like they were kneeling in front of the drummers while clapping and singing along.)
After lunch — which, as is typical in Malawian restaurants, was mostly chicken and chips — we stopped for petrol. Can you tell this place used to be British? Then we began driving around to see the sights. First was some form of clock tower / monument. It was under renovations, so the plaque explaining what it was and why it was there had been removed. Next was Capital Hill, which was exactly what it sounds like — all the government buildings. It’s basically an enclosed ring road with each ministry having a building inside; the Parliament building is still being built just beside it. We stopped a couple times to look around and take pictures; we were even able to drive right up to the door (not the gate, the actual door) of the President’s office building! Try that at the White House or in Ottawa!
The last big thing we really wanted to see was the mausoleum for Dr. Hastings Kamuzu Banda, the founder and first president of Malawi. We had difficulty explaining this to the driver — he didn’t know the word ‘mausoleum’, but was convinced it was the same as ‘museum’. Fortunately, he wanted to see Banda’s “graveyard”, so we told him that was just as good. It was quite an impressive, not overly huge, mausoleum with some nice gardens all around. We met a tour guide / caretaker, and he showed us around, starting with a brief history of Dr Banda (which I will spare you here), then taking us past the forbidden lower level. This is where the actual casket, headstone, and body lie; because of the family’s wishes, these are not available to the public. Instead, we went upstairs to an open area where they have exact replicas, along with a big portait, some flowers, etc. As we were walking around the back to go sign the guestbook, the caretaker decided he liked us. (Because we’ve been here long enough, and have spent some serious time at the dinner table discussing politics, we knew much more about Dr Banda and the other two presidents Malawi has had since than most visitors do, I suppose.) He commented that the lower level was being cleaned today, and he would allow us a quick peek, but emphasized that this is something that does not normally happen. We went into a small ‘viewing room’, which had a window onto the room, so we got to see the real thing… in a dimly-lit room through a thick window. It looked the exact same, so far as I could tell, as the replica, but it still felt special getting the sneak peek. After signing the guestbook and making a small donation to the ongoing maintenance of the monument, we were off.
Little to our knowledge, we actually had a series of small errands to run. In the process, we drove past a couple of Lilongwe’s famous buildings, which are known for their innovative architecture — when I get back to Canada and post pictures, you’ll see what I mean. We had to buy batteries, then more batteries because the first ones weren’t any good, then a cellphone, then we had to pick someone up, then buy another cellphone, then some shoes, then a watch…. most of these, fortunately, were quick five-minute errands that involved us waiting in the van while somebody ran out and grabbed something. Eventually, around 2:30, we hit the highway and started back.
We were driving for a good couple hours before having to stop. We stopped at an area where there were dozens of buckets of potatoes at the side of the road. Accordingly, dozens of people who had been gathered around a fire maybe 25m away ran as fast as they could to their particular pile of potatoes and tried to explain why theirs were the best. Everyone but us — i.e. the two optical people plus the driver — got out, looked around, and eventually settled on a couple buckets from a lady with a little baby. Frankly, all the potatoes looked the same, so I think I’d have bought them from a woman with a little kid, too. On the road again, we stopped maybe half an hour later at what was a legitimate market this time. Immediately, people started swarming the car with their baskets of anything and everything imaginable — beans, bananas, oranges, cabbage, garlic, onions, more potatoes… The optical guy got out of the van to try to talk civilly with the vendors — this is something that becomes impossible as twenty people are pushing for windowside access. Between all of us (Mark and I included) I think a little bit of everything was purchased, except maybe the beans, because there were several different kinds. Mark and I got bananas, which were delicious (I think we each had three on the way back) and some form of either apricots or peaches (they’re small, but look more like peaches) which weren’t quite ripe yet. One woman selling potatoes was rather unimpressed that they’re already bought their potatoes, and insisted that hers would be better.
Again, less than an hour later we stopped. This time, the only thing in sight were giant bags of charcoal. By this point, the van was quite full of cabbage and potatoes and things, and we didn’t see why they needed charcoal — it’s sold everywhere here, including the local markets. Somehow, they managed to fit three giant sacks of charcoal into the back of the van, so we were off again. Since the van was full, and we had bought basically every product that is available at the side of the road, I figured we were done stopping… until the van slammed on the brakes. I looked out the window and saw a boy, maybe 12 years old, running towards us with what looked like flowers or something on a stick. Turns out they were some form of roasted birds. (When I saw “birds”, I don’t mean like chicken or turkey; I mean like robins or sparrows or something.) After some arguing, the optical guy bought the boy’s whole stock, maybe six sticks with five birds each. Mark and I were invited to try one… I went first, and, since I had the window seat, gave the boy and his younger brother a great deal of fun. Apparently, eating random roadside birds from the middle of nowhere is not common among white people. I waved, they waved, and all was good — we started driving again.
Our next-to-last stop was in a random village. This time, the driver parked the van in the driveway of a random shop. Most of the shops here are rather random, and the names are either incredibly descriptive of what’s inside (like “Electrical Electronics”) or are incredibly vague (”Ngwenze Store”, for example). In the latter case, there’s usually a sign saying “Specializing in…”, with a list of things available. Sometimes these make sense — like “resthouse and restaurant”, or “grocery and cosmetics”. In this case, it made no sense — “panel beating, arc welding, coffin makers, and maize mill”. (Coffin makers are surprisingly common — in our hour-long drive to Mulanje a week or two ago, we saw at least eight on the way!) After five or ten minutes, the driver emerged with a giant (50lb) sack of what I’m assuming was maize flour… it turns out this crazy place was where his father lived! Always good to have a coffin-maker in the family, right?
Shortly thereafter, we arrived safely back at the house. We had a quick dinner, which was waiting for us — with all the stops we’d made, we weren’t home when they’d expected — and went to bed for a good night’s sleep, with no yelling, knocking, or retiling.
Sunday’s stories next.
One of the things we’d wanted to do in Lilongwe was to look at the curio shops. Because Malawi is such a poor country, and most of the tourist draws are natural things like parks, mountains, and the lake, most markets don’t tend to have any souvenir-type things at them. Lilongwe, though, being the capital city, tends to get a lot of random visitors, between government activities and the airport and so on, so there are a few curio shops that were supposed to be quite good. Of course, the way our trip to Lilongwe went (i.e. completely randomly) we didn’t have a chance, so we decided to make the most of our Sunday and head to Blantyre, which also has a couple curio shops in the downtown area, between the hotels and banks.
We got a drive down from the mother we’re staying with — she had a bridal shower to go to in town, so it wasn’t too far out of the way, and we know how to take the minibus well enough now. She dropped us off around the corner, though, warning us that two mzungus (the Chichewa word, as well as Swahili, for “white person”) getting out of a fancy car would inflate the prices even higher. The curio stalls, as it were, was basically a small outdoor market with vendors everywhere on the sidewalk — there were proper shops down the street, but we knew we could bargain and barter on the street. We walked up, and immediately a man ran across the street to us, offering to show us around the market, starting (of course) at his stall. Since his stall was the closest to us, we would’ve started there anyways, but still. We were basically swarmed the entire time we were there, and they were all yelling “Me next!” “No, me next, then him” “No no, my name is Charles, you see my shop” and so on. They had a pretty good selection, and although the prices were quite high (especially initially) I don’t think either of us got ripped off too badly. It’s also difficult in a situation like that, because you want to help out as many of “the little guys” as you can, but you’re in a better situation to bargain when you’ve got a bag full of stuff from the same stall. They had quite a good selection of carvings and trinkets, local artwork, and all sorts of handmade crafts and things. Generally, they were pretty friendly, if not overly aggressive, and they offered to trade our things for theirs (Mark traded away a couple wristband things, and we were offered to trade for our shoes… which we were still wearing), so I imagine I’ll go back towards the end of our time here and trade away some things I don’t need — extra clothing and that sort of thing — for some more goodies.
But the shopping doesn’t end there. I’d already withdrawn all the cash I could — my ATM limit is stupidly low — and I really wanted a couple little paintings, but only had enough cash for one, so I got the one I liked better. Then another vendor pulled me aside and said I could pick one of his paintings that was similar and pay him tomorrow. He also chided me on buying a painting from the other guy — his paintings are hand-done by his hundred-year-old grandfather, while the other guy’s are done by some fifteen year old. (Both paintings, it turns out, have the exact same signature on them…. go figure.) Anyway, he was very friendly, and one of the few who didn’t seem to be as pushy — some of the vendors went as far as shoving stuff into our hands and, in Mark’s case, wouldn’t take “no” for an answer — so we traded cell numbers and agreed to meet, just the two of us, at the hospital. I knew he wouldn’t being anyone else along because he wouldn’t want to share any business, and the hospital is a big enough landmark with security, so he couldn’t harass me too much anyway.
So the next day (yesterday) comes along, and he shows up at the hospital looking ridiculous. He’s wearing two straw hats, like the stereotypical prairie farmer kind, on top of one another, and carrying a backpack of stuff. He’d offered to bring a few things along, things that weren’t at the market but that I was looking for anyways, so Mark and I took a look, argued about prices, and ended up buying a couple extra small things. I paid my debt — in US dollars, rather than the local currency, because of the ATM difficulties — and we shook hands, took a photo, and talked a few more minutes. He said he has lots of connections, which seems to be the truth — his was one of the few stalls that had a little of everything — and he told us to call him if we need anything else. “Don’t go to the market, it’s too busy there, too crowded, you can’t talk, you can’t get what you want. Call me, I come visit you.” His name was Hapiness (spelled with one “p”), as he kept reminding us, and that’s what he brings.
As a couple small side notes: The ATMs here are, in typical Malawian fashion, a tad unreliable. They accept our cards intermittently, and sometimes they claim they can’t connect to our banks. Once mine worked, followed almost immediately by Mark’s being rejected. On the plus side, there’s an ice cream place where the ATMs are, so when we’re feeling rejected, we can melt it away with some cool vanilla sweetness. (Vanilla is the only flavour, unfortunately….)
I had a surprisingly productive Friday this week. Usually, here’s how the schedule goes.
Morning: Go to work, do ward rounds, check on all the post-op (cataract) patients… i.e. nothing exciting.
Afternoon: Go home (half days, remember), have lunch, and do nothing all day.
This week, Dr Kalua seemed more annoyed than usual. He started on a little rant about how he wanted us to do two things, but now the world’s coming to an end and we can’t do whatever his special little project was. We were confused, and we asked. It turns out he’d found a couple boxes of old donated glasses that he had wanted us to neutralize and sort them so that we could hand some of them out in a couple weeks. We’re going up to Mangochi, which is somewhere near Lake Malawi, for four days or so to do an outreach program there, so if we could bring glasses with us it would help. Anyway, when Dr Kalua went on his computer database to see how many lensometers he had in the hospital (and, presumably, where they were) it told him four. He knew he’d gotten a new one too that wasn’t in the computer yet because it was new still in the box, so that made five. In his morning round of the hospital, including asking everyone he could find, he found out on was broken (and subsequently misplaced), one had been permanently “borrowed” by the optical lab, who need it to make glasses, and the other two were missing in action. He went into his boss’ office to open the brand new box, and discovered that it was empty — the boss had already taken it out without telling him or putting it in the computer! So, by the time we talked to him, he was already convinced that it was impossible for us to do what he wanted. (Never mind that we still have all of next week….)
Anyway, I guess somebody explained to the optical lab why we needed to use their only lensometer, and about a half-hour later it appeared at our door. The optical people like us, partly because we understand what they do, partly because we share a drive home every night with the dispensing girls, and partly because we went to Lilongwe with the optician guy. So, we were able to do lensometry on a couple hundred pairs of glasses. This gave us a pretty good sense of accomplishment; most of the time, doing ward rounds or working in the outpatient clinic, we’re always a bit hesitant because we’re still not completely sure of the wacky diseases we see here. Lensometry we know. We were also told to set aside anything with significant cyl (astigmatism), because we didn’t have enough to bother checking them all and trying to sort them, and if we started giving them out to people without astigmatism they’d hate them because everything gets all distorted. This made life easier, as the lensometer we had didn’t have a way of rotating the target, so we wouldn’t have been very accurate on the axis anyway.
At lunchtime, we met up with the driver. He took us downtown Blantyre to the Immigration department so we could get our visas extended; we were only given thirty days (which is all anyone get, apparently) at the airport, and our time was almost up. The driver knew that they closed for lunch from 12:00 to 1:30, but we all learned when we got there that they close early on Fridays, at noon. (Other departments were open, but the section for foreigners needing visa attention was closed.) Fortunately, they’re open on Saturdays too, so we made plans to go the next morning.
After dropping off my things at the house and getting a drink, I went out again. I was feeling restless, and quite often on the weekends we feel ‘cooped up’ at the house, so I decided just to go and sort of wander around town. I took the minibus — surprisingly, it was full in the middle of the afternoon — to where it lets me off, downtown near the market and a bunch of little shops. I bought some sugarcane and started my wandering.
The minibus had left me a little further from the market than I was used to; this was a good thing, in my mind, because it forced me to walk past a bunch of little shops. I looked in a couple, because there’s still a couple things I wanted to buy but didn’t really need, and had some random conversations with the owners. Everybody seemed to think I was British, which is funny, because everywhere else in Africa they’ve assumed I’m American. You’d think, for a former British colony, they’d be able to figure it out when you’re talking to them. I ended up taking a little path into the edge of the market. This is where I began causing a small riot. There were four little kids in a cluster, and they started following me. This isn’t unusual; typically they see white people and start begging for either money or a sweet. Usually I ignore them, except I realized this time that I actually had candy in my pocket; I usually keep four or five suckers in my pocket for the children we see at the hospital. This was all well and good, except by the time I got the candy out and managed to open the wrapper — for some reason, they seem to be childproof — I realized there were only three. One of the boys (the oldest) helped me open the wrappers, so he gave the first one to the youngest sister, the next one to the other sister, and immediately ran off with the last one. That left one little boy clearly wondering where his candy was. I told him “I’m sorry, I don’t have anymore… go chase your brother”. So he did!
I kept on the path, got across the creek that cuts through the market (there was a board to walk over), and reached the back end of the market. It seems like along the main road, the market has the more common things that people need — there’s a clear area with clothes, another with electronics, food, etc. I seemed to be in the “random everything” section — there was fabric and tailors, candy, laundry soap, underwear, anything you can think of… plus more people selling sugarcane, who started yelling at me (in a friendly way) in Chichewa…. all I could do is smile and wave my sugarcane at them. A lot of the vendors yell out to anyone who’s white, mostly because it really is a local market, not intended for tourists, and all the white people who actually live here do their shopping at one of the malls or plazas around. One guy came running up to me and offered to show me around. I didn’t feel like explaining that I knew where things were, or that I didn’t need anything specific, so I followed him. We went to one random stall for me to meet his friend George. Then we went somewhere else to meet his grandmother and sister. He seemed to know all the other vendors — not surprisingly, considering he works there — and we went dashing off again. He started telling me how poor he is and how hungry he is and all this stuff. This, too, happens all the time — even where we got our curios from, they were telling us how small and poor Malawi is — so I wasn’t too surprised. Rather than money, I gave him the rest of my sugarcane, which he ate very quickly while leading me between the stalls. We ended up in some back area where there were a couple small ‘restaurants’. He said lunch, which was a plate of beef and nsima, would cost a hundred kwacha. Since he clearly was actually hungry, and he’d given me a bit of a random adventure already, I figured I’d buy him the food — it’s less than a dollar anyway. He offered me to sit down with him, so the two of us had a snack together. The owners of the ‘restaurant’ — a stall with a couple benches — were a husband and wife, who thought this was pretty funny, and they kept talking to us the whole time. They were teasing us because we didn’t know each other’s names. When I asked his, he yelled “BAAAAAAAANT!” My response was to stare blankly, and then say “…Bant?” Apparently that was close enough.
Towards the end, their kids (teenagers) and their friends showed up, too. Once we’d finished eating, Bant was ready to go, but I wanted a picture of us at the little restaurant to remember the whole ridiculous situation. One of the teenagers offered to take it, but he couldn’t seem to figure out the shutter button — he kept pushing the shutter halfway, then moving his finger to the power button and turning off the camera. His brothers or friends, of course, found this quite hilarious. After a couple random misfires, we got our picture. By this point, a number of people from the neighbouring stalls had come over to see what was going on. A lot of them had clearly never seen a digital camera before; even the mother-owner where we were didn’t quite believe how it worked until her son took her picture and showed her! We left quickly, as Bant seemed to have somewhere else in mind. We weaved through the market until we got to the street where the minibuses are. He offered to show me his village. This was, of course, rather out of the question — it’s one thing to wander through the market when I know where I am, but quite another to get on a minibus with a stranger and go to some random village. I explained this to him, so we started back to where we’d initially met. I asked him if he could help me find something since he knows the market so well. I explained what I was looking for (with some difficulty) and we went around looking. He claimed to know exactly where to get it for the best price, but after a few minutes I realized he had no idea if it was even sold in the market, let alone where it would be. He asked a few vendors, and they weren’t any help, either. At one point we actually exited the market, crossed the main street, and ended up in some random place where people sell firewood. Apparently, these were his friends, and he started pointing and waving his hands at some of them. I realized he wanted pictures with them, but didn’t know the word for camera. They, too, seemed amazed at “the machine”, as they called it. But then, as we were heading back to the market, one of them pulled out his cellphone, which had a camera, and took a picture!
Finally, as things were starting to wind down — the market closes at 4:30, officially — I caught a glimpse of what I wanted, so we worked our way over there and started talking with the guy. I got what I wanted, then we walked back up to the main street. I wanted a drink, and bought Bant a Coke too for “helping” me. I headed home, and then realized that it was perfect timing. The sun here “sets” around 5:30; it’s actually up for another hour or so past that, but because there’s a mountain, it disappears behind there and gets darker earlier. But a few minutes before that, around 5:15, the sun is a brilliant bright red colour, and clouds and mountain light up, and it’s almost a picture-perfect African sunset. So, I was walking the last little bit home, and had my camera, at the exact right time to get a picture of this. Usually, we’re in the van coming home around 5:00 or 5:15, so we can’t possibly get a picture except out the window of a moving vehicle, but it worked out quite well.
So that’s the story of my Friday…. Saturday’s stories next.
Well, Mark and I are still in Malawi legally, thanks to the Immigration and Visa department in Blantyre. The Malawi page in my passport looks ridiculous, though; they tried to fit three stamps on there and it barely fit, overlapping a bit. Unlike Tanzania, which printed off a real visa, Malawi does a combination of rubber-stamping and handwritten codes and dates. We had three people helping us, all of which were trainees (according to their name tags); they were doing some serious mental arithmetic trying to figure out what the right date was to put for a one-month extension. In any case, it’s all taken care of now.
We’d been thinking of going to the Shire river to see some things. (Incidentally, “Shire” is pronounced “She-ray” here, for some unknown reason.) There’s some old sugar mills and stuff, plus hippos and crocodiles and elephants to see. The father of the family we’re staying with was going to bring us — he decided last week he wanted to go, out of the blue — but they had some errands of their own to do, and by the time they got back it was too late to start off. Rather than sticking around the house and getting cabin fever again, we took the minibus into Blantyre.
We’d heard that the Museum of Malawi was somewhere along the main highway between the house and the hospital. We’d been looking for it (unsuccessfully) for weeks before driving past it on one of the side streets; the actual entrance isn’t on the highway, but the building is. It’s near the French Cultural Center and Embassy, which we’d only noticed because it has a giant picture of Celine Dion on it. (Why the French embassy thinks they can claim Celine Dion as their own is beyond me.) It’s also about a block down from the big mall.
We started off at the museum, which we’d heard was small and free. Well, that was half right — they’ve started charging admission. It’s twice as much for foreigners as Malawians, which still only amounted to a couple bucks each. Size-wise, it’s about twice the size of the Earth Sciences museum in CEIT (”the dinosaur building”) in Waterloo. There was one room with some stuffed (taxidermy, not plush) animals from their National Parks, as well as a display case of insects. There are tons of crazy bugs here — giant spiders (yeah I know, not insects), cockroach things, two-inch long bees, beetles — and we’ve seen a few that weren’t in the display case. Then there was another room with all their cultural stuff, old stone-age carvings, weapons, costumes, and other historical stuff. There were also some mannequins dressed up in traditional clothing and posed as if doing one of the famous dances.
We went outside thinking it was done, then noticed there was a large locomotive under an overhang that looked suspiciously like an exhibit. Sure enough, it had a plaque, and there were a few other things there too. There were about three old steam engines, a fire truck, a delivery truck from when Malawi was called Nyasaland (which, admittedly, wasn’t that long ago, maybe 50 years or so), some farming implements, etc. There was also a bunch of kids playing on the tractors and trains and things. They weren’t that interested in us at first, but when we went over to check out a model traditional hut, one of them came over to say hello. He wandered into our pictures, accidentally at first but then deliberately. We finished our loop of the outside, then headed back because I wanted to take a better look at the fire truck without people everywhere. By this point, the kids had produced a “football” (not a real ball, it looked like it was made of rags or something) and were kicking it around. Somehow Mark got roped into playing with them while I climbed into the truck. There was barbed wire on the door, so I had to go in through the window/roof. (The kids assured me that people do it all the time, and their ease at climbing up to join me leads me to believe them.) It was nice just hanging out for a few minute with these kids — who, by the way, didn’t seem to understand that we don’t know Chichewa — who didn’t want money or candy but just genuinely were interested in the funny-looking white people.
We walked down to the French Cultural Center. They close early on weekends, so they were closed. The security guy was looking at us kinda funny… probably because most white people here don’t walk places, and also because we were switching back and forth between French (reading the signs with hours and explaining that there was both an embassy and a cultural center inside) and English (normal conversation); people here have enough trouble with English that I don’t think he wanted to talk to us unless he had to! So, we got to see the outside, which looked fairly nice, then went to the mall for ice cream.
Lisa, one of the students who came to Malawi last year, had warned us that Malawians aren’t very good with ice cream. We’ve had it a few times here, and I’d have to disagree. It tastes a bit different, and the texture can vary greatly, from very icy to very creamy, but it’s still good. Unfortunately the place we usually go has issues with their soft-serve machine. I suspect this is largely due to the fact that it’s almost outside — it’s one of those places without real doors. So instead we got a cold drink, then got some ice cream at the grocery and ate it instead.
Since it was nice, and we weren’t in a hurry to get home, we decided to walk back. It took about an hour, and gave us a chance to see some of the things that we drive by every day but can’t really see. We stopped and took some photos at the Independence Arch, which is a monument that goes over the highway between Blantyre and Limbe. Oddly enough, it’s not an arch; it looks more like an American tollbooth with a big tower in the middle and spears around it. Further along, we found the Canadian Consulate. It’s quite tiny, but had a giant flag, which was my first clue that it was there. We started taking pictures, then some random guy from the adjacent shop came over to tell us not to take their picture. We tried explaining that we’re Canadian so we wanted pictures of the Consulate; he didn’t seem to understand, but I showed him the pictures (without him in it) and he seemed satisfied, if a bit confused. Admittedly, it’s not very photogenic — certainly not like our embassy in the US — but still worth a photo when you’re this far from home.
After stopping at the market for another drink (at the same place I’d been the day before — the guy definitely remembered me, and gave us a seat this time), we headed back home. Luckily enough, we were just in time for the sunset again, and tried again to get pictures. It’s not hard to get decent photos, but they don’t do it justice — the sun gets really red as it sets! Hopefully I can tweak the colours on the computer; if not, they’re good enough to help me remember what it really looks like.
We’re no longer the only students here at the eye hospital… we’re also no longer the only white people, not by far!
Monday saw two new students arrive from Holland (Utrecht). They’re very nice girls who are interested in tropical medicine and chose to do their ophthalmology rotation here in Malawi. Since the doctor they were supposed to be with isn’t here — he was in Germany, and was due back, except he had a heart attack, so they’re keeping him under observation for a week — Dr Kalua got stuck with them. He only learned this on Monday morning, so we’ve been showing them around and teaching them what we can.
Tuesday, three German doctors arrived. We weren’t properly introduced; rather, we ran into them when we noticed a man getting changed out of scrubs in the room we usually have lunch in. After assuring him the room wasn’t scheduled to be used for anything, he seemed less embarrassed. They’re pediatric ophthalmologists, which means that the paeds ward is absolutely crawling with little ones… even more than usual. Apparently all the young kids with congenital cataracts that we’ve seen for the past few months have all been told to come back these couple days so they can be checked. Hopefully they know what they’re doing and brought what they need — so far, when we do anything surgical with kids, it has to be done under general anaesthesia, which takes forever, so you can only do three or four surgeries in a day, tops. We also “borrow” anaesthesiologists from the main hospital, which is tricky to arrange.
Tomorrow — or today, as this is posted — Dr Kalua’s second surprise arrives. The fourth-year med students from the Malawi College of Medicine (which is right next door, conveniently) are starting their two-week ophthalmology rotation. This is horrible timing, because their first day, Dr K is scheduled (as are we) to be doing an outreach thing in some random village… and next week, we’ll also be gone. This means that everyone else will not only have to deal with his absence, but also have thirty clueless pseudo-doctors running around trying to figure out the difference between an eyelid and an eyelash. (These were his words, approximately. If the Dutch students are any indication, they’ll be more prepared than that!)
So yes… as the title says, “Great Googly!” This was my general reaction today in the OPD (outpatient department) of the hospital. We’d done ward rounds first thing in the morning, and had been explaining things to the Dutch students. (Yes, they have names: Inge, which I can pronounce, and Willemyn? which is where we usually stumble horribly.) We’d said that all the stuff in the ward (minus the cataracts) was usually pretty rare, serious, or end-stage diseases, and that the outpatient department wouldn’t be as interesting for them because it’s pretty repetitive most of the time. This was not the case today! After lunch, we took over the outpatient ward. Usually there’s nobody there in the afternoon, because it’s much easier for them to travel in the morning rather than during the heat of the day. We were walking by to check it out and saw a half-dozen people waiting, so we started seeing them; the Dutch students joined us shortly thereafter. We started with a couple normal things, like allergic conjunctivitis and inflamed pterygia (a bump on the eye), and managed with our broken Chichewa, the patients’ broken English, and the occasional help of a security guard or anyone else passing by. Then, in came a patient I’d seen the day before. She’s my age, but her retinas looked absolutely destroyed, as if she’d had diabetes for ten or fifteen years. I’d sent her to get checked for diabetes — it happens here more than I would have guessed — and she came back with a normal fasting blood sugar reading. (Dr. Freddo would be proud to know that his students are allowed to order blood work….) The other possibility was what we call “malignant hypertension” — blood pressure that’s basically so high it’s off the charts. After pestering the nurses, I got the cuff and a stethoscope and got her set up. At this point, I’m fairly sure the Dutch students were baffled — we’d spent a good time this morning trying to explain what optometry is and how we aren’t “real doctors” who do medical school and all that. Like a lot of countries, especially in Europe (and Malawi as well!), they don’t have optometrists — they have opticians, who can refract and prescribe glasses, and then they have ophthalmologists, who do everything disease-related, medical, or surgical. Anyway, I haven’t measured blood pressure in ages, so I double checked the reading I’d gotten. Sure enough, she was at malignant levels — 200+/120. (Depending who you ask, normal varies, but definitely the bigger number should be around or under 120 for someone our age… something like 120/80 or 110/70.) Usually we’d start treatment and admit her to the ward just to make sure the medication works; unfortunately, while we were trying to set that up, she found out her brother’s in the hospital and she couldn’t stay. Since I couldn’t find a nurse, doctor, or anyone else qualified, I scribbled down the first medications I could think of on a prescription for her to take to the pharmacy and told her to come back as soon as she could. (Would Dr. Freddo be appalled at the idea of an optometrist prescribing BP meds? Probably.) I’m sure the pharmacist will wonder who prescribed such a thing, and probably ignore what I wrote and just give her a proper set of medications. All of this is well outside our scope of practice in Canada, I might add… although so is at least half of what we do here. Ordering injected medications? Sure! Giving them? Why not! Oral steroids, antibiotics, antifungals? Absolutely! Not to mention ordering blood work, HIV testing, X-rays and CT scans…
So while trying to explain to the new students the difference between normal hypertensive retinopathy (what you’d see in Canada or Holland) and what this girl had, another patient stumbles in. Literally. At first I thought he had a strabismus (an eye turn… like being cross-eyed), except then I noticed his eyes were moving separately. Sometimes that can happen, but it’s usually horizontally. This guy’s were moving like a chameleon’s — up, down, around, and in completely different directions from one moment to the next. Unfortunately, aside from that, they looked fine, except for a dilated pupil and a slightly droopy eyelid. (Optometry people, you should know where this is going!) This meant it was time to get a translator! We got one of the clinical officers to try to set things straight. It turns out this guy had been in a serious car accident a few months ago, was “unconscious” (we think a coma) for an unknown amount of time, and had some brain damage. (As an aside, the Chichewa word for brain is “bongo”… it’s very hard not to laugh when they say “bongo” and point to their head!) By getting him to follow some instructions and follow things with his eyes, we figured out he’d had damage to at least two of his cranial nerves (which control the eye muscles), which is irreparable, meaning five of the six muscles moving his eye around are basically shot. Fortunately, his eye with better vision is also the one where he can control the muscles better, so he’ll adapt quicker and start to ignore the double vision.
Anyway, we continued seeing some more patients, most of whom were fairly normal. Then, once we’d thought everyone was gone, Mark looks out and notices that that guy is still there. I didn’t know who, so I asked “the guy with the googly eyes?” No, it’s not politically correct, but if you saw it, you’d agree.
Well, I found out today that the hospital pharmacy had successfully filled my prescription for HCTZ to control the random lady’s blood pressure. (This is surprising, because I hadn’t put a dosage or how many times a day or any real instructions on it.) Hopefully it works! The patient’s boyfriend/husband/brother had come by because they were out of the other drug I’d prescribed (Diamox, which is the only thing I could think of that I actually knew the dosage for) but had substituted something else and wanted to run it by me. I don’t honestly know why they check — the pharmacists seem to have a better idea of what’s going on than the patients or the doctors half the time.
My teaching career had a step up today. The medical students, all 34 of them, were piled into the lecture room for an introduction to the eye unit. Dr Kalua introduced us as optometrists from Canada. (Not students — optometrists.) This was nice, because it meant that later in the day, when we needed a translator, we could more or less ‘demand’ it. Rather than going with Dr Kalua to Chilazu, the smaller town where he was going to be doing more outreach cataract surgeries (and we would be bored watching him do surgery all day), we were given a small group of students to teach. Since most of them didn’t have scrubs, we ended up with the ones who would have otherwise been observing surgery. Frankly, it’s better that they didn’t observe today — the power went out (again!) and the patient woke up (again!) and the surgery (repair of a perforated cornea, again) wasn’t nearly finished, so they’ll have to be checked and probably touched-up tomorrow. If my first exposure to ophthalmology involved a patient waking up when sharp metal instruments were in his eye, I know I wouldn’t want to go into the field!
So we took our students (and the Dutch students) into the outpatient ward, gave them a quick tutorial on the anatomy of the eye, as well as how to use the basic instruments — a slit lamp, which is “a big fancy microscope”, as I like to call it; and a penlight, or “torch”, as the British English here seems to call it — to look at the eye. We started seeing patients fairly slowly, taking time to explain what we were doing, what we were seeing, and letting them look. Unfortunately, with a lot of things you have to see a lot of normal eyes before you can tell that something isn’t right — the colour is off, or it looks a little too thick, or whatever. The first few patients were easy things, like allergic conjunctivitis. Then, once the clinic officers realized that we were there (which, for some unknown reason, usually takes a half-hour or so), we started getting sent the more interesting (read “difficult”) patients. They also send us everyone who needs a fundus exam… which is fun, because they do this even once we’ve left the outpatient clinic, then an hour later we’ll find someone randomly walking around the hallway looking for the white doctors who were supposed to see them. They never ask us if they can send patients for fundoscopy, or tell us that there are patients waiting; we’re just supposed to figure it out. We saw a textbook case of diabetic retinopathy, and the man was kind enough to let six people look at his eyes. (He had “regular” diabetic complications in one eye, and “Malawian-stage” complications — i.e. a massive bleed — in the other.) Surprisingly, the Malawian students were able to see the smaller bleeds in the “good” eye with the direct ophthalmoscope — during the lecture, Dr Kalua had said he’d seen students at their final board exams before who didn’t even know which way to hold it! We also saw a couple kids with minor infections, one infant with a more severe infection, a tumour, and a couple other things that we were able to make interesting for the students. For the most part, they seem like quick learners, although they aren’t necessarily all that interested in ophthalmology itself. They also seem to have a decent background in the anatomy of the eye, at least — certainly better than Dr Kalua’s expectation that we’d have to explain to them what eyelids were! (I would have thought he was kidding, except he said it several times.)
The Malawian students left partway through the morning to go see surgery, but I feel as if we gave them a really good introduction to ophthalmology. They know how to use a penlight and ophthalmoscope to see the eye, they have a decent idea of what they’re looking at when they see an eye (even under high magnification, like the slit lamp), and they have a basic idea of the sorts of problems we see commonly and the drugs we have available to treat them. We then took the Dutch students to do ward rounds. Dr Kalua had specifically told us not to do ward rounds until we’d discussed it with the visiting German doctors, but somehow this hadn’t gotten through to the nurses. This meant that all the patients had been lined up and waiting for the better part of three hours by the time we got there! We made a list of the ones that our visitors had to review carefully, and left most of the children for the specialists, but we went through the rest fairly quickly.
Then it was lunchtime. Since we’d thought we’d be out somewhere, neither of us had brought anything to do, and the internet wasn’t working. We went to the mall, which is a fifteen minute walk away, and were disappointed to see that the ice cream machine (soft serve) was broken, so there was no ice cream to be had. We weren’t the only ones walking away empty-handed, either. I’d say I hope they fix it, but I doubt it’ll be done before we leave.
After lunch, the medical students had a lecture to attend, so we took the Dutch students to the ward. We’d spoken to the German doctor, who said we could see the children and just make a list of anyone we thought could use surgery tomorrow. We did this, but there weren’t many children (which is odd, because there were a zillion running around in the morning), so we finished quickly. We went to the outpatient clinic again, where we saw a couple dozen patients waiting, and noticed that there was nobody else seeing patients — they were all being sent in, but there was nobody to help them. We started calling them in, and did our best to figure out what they needed done or what their problem was. I managed to successfully diagnose a small child (nine months old) who had a very mild bacterial conjunctivitis, which amazed the Dutch students, because none of us could see anything wrong, and I only said one word to the mother. Usually you’d see red eyes or a discharge or something; the boy had none of this, he looked normal except for a little crusty junk in the corner of one eye, like you get when you wake up sometimes. I used one of my few optometry Chichewa words — “manthongo”, which means “discharge” — and the mother’s face lit up, she nodded, and pointed to both eyes. Fortunately, the prescriptions are written in English, and the word “pharmacy” is the same in both languages! We had a couple odd cases again in the afternoon, and had to depend on everyone from doctors to passersby to the security guard to translate for us, but we managed to run the clinic without any supervision or official translating for almost two hours. I also got to fill out a police report, because one of our patients had been assaulted in the eye (whatever that means) and part of the report involves a medical assessment. Luckily, she was just a little swollen, and had a subconjunctival hemorrhage, which is the ocular equivalent of a bruise.
At the end of the day, we saw that there were still a few patients left. We managed to get a very nice Malawian med student who had stayed later than all her classmates to translate for us. She was exactly the kind of person that you want your doctor to be, very kind and interested in talking with the patients and helping them as much as possible. We’d ask her “why is this patient here” and she’d talk to them for a couple minutes, giving us all the details we’d have asked for. Since we were trying to teach her about every patient’s condition, she managed to give them excellent counselling as well, which is something we’ve seen lacking for the most part here. I don’t know where she was in the morning, but she hadn’t been shown how to look at an eye at all, so she got a quick crash course on that from us, too. All in all, I like having the students around — as our time in Malawi goes on, our learning curve is starting to plateau, and we start running out of new interesting conditions to see in patients. It’s nice to be able to share our knowledge, to pass it on, and to realize how much of this we’ve learned here in the past few weeks.
The last couple days haven’t been all that interesting. Most of the medical students have either been avoiding the eye hospital altogether (except the lectures, where it seems they take attendance) or spending as much time observing in the operating theatre. Frankly, I don’t see how any of them would want to observe surgery, especially more than once. The theatre is small enough with me and Mark in there, let alone twenty or thirty extra people. There’s no way most of them can see what’s going on at all, and it’s not like they have a TV hooked up to the microscope like some places do. (They have a microscope that can do this, but it’s broken…. actually, they have three, all of which are broken.) Eye surgery in itself isn’t all that interesting — most things here (other than cataracts) are tumour excisions, corneal perforation repairs, and enucleations, all of which are just cutting at random and/or stitching. They did one strabismus (eye turn) surgery today, which is the first that’s happened since we’ve been here, but everything else is fairly routine — unless they want to become surgeons, I expect more of them will start wandering into the wards and clinics starting soon. Which is great, except we won’t be here…
This is likely the last update for a week or so. Later today, we’re taking a bus up to Liwonde National Park, which is on the Shire River. Apparently it’s impossible to go there without seeing hippos, which should be good. We’ll spend a couple days there, then hopefully a day at Cape Maclear on Lake Malawi, before going to Mangochi, where we’ll be doing a four-day outreach eyecare program. We’ll be back in Blantyre working for one last day, then have the Saturday to pack before flying out on Sunday… if I get a chance to update again, that would be good, but otherwise, you’ll hear from me when I’m back in Canada!
After discussing our weekend plans with our host mother, she recommended that we bring a guide with us. We were planning to do a great deal of travelling that involved switching minibuses and that sort of thing, and she said having someone with us who could translate and keep us from getting ripped off would be a good idea. (She’s a student/graduate of the Tourism program in Malawi, so she knows people who do exactly this.) He met us at the hospital after lunch, and we got on a minibus to Limbe, where the main bus station is. From there, we found a larger minibus that was going to Liwonde. Fortunately, the bus was almost full — there’s no schedule here, it’s just when a bus is full then it leaves.
We got to Liwonde fairly quickly, and got off at the gas station in town. We were immediately mobbed by bicycle taxi drivers, who saw white people and assumed (correctly) we still had a ways to go. Somehow, our guide decided which of the bikes was best — the all look the same, but we had to pick three — and we were off. It’s 6km from the town of Liwonde to the gates of the National Park, but it went surprisingly fast on the back seat of the bike! It was also surprisingly cheap, less than $3 each. We arrived at the gate, and realized it was just Mark and I. This was the first time that we managed to lose Chisoni, our guide. After a few minutes of waiting, I called him — apparently his driver had managed to blow a tire in the process, but they were up and running again and almost there.
At the gate, we met the cheeriest Malawian yet, I think. He was a park ranger, and was responsible for figuring out where we were staying and how much we should be paying for the park entry fee. He was also quite particular on how the receipt is filled out. He gave us lots of good information, and arranged for us to get a ride to the closest campsite. (There are two — one was 3km from the entrance we were at, the other was closer to 50km away!) After a bumpy ride, we got to the lodge and made arrangements to stay in the dorm. We dropped off our stuff in the room — even though it was just “a weekend off”, we had to bring everything we’d need for the rest of the week in Mangochi, including our optometry equipment — and rehydrated ourselves. The lady at reception helped us arrange some “game viewing”, as they call it, and we chose the early morning one so we’d have time to do other things the next day. We still had a little bit of time before the sun set, so we wandered off down the path towards the Shire river. There were a bunch of antelope there, either impalas (which they looked like) or waterbuck (which would make more sense, being beside the river). They kept watching us, but let us get pretty close before running off. It was pretty cool, watching the red African sun set over the river and marshlands with impalas running around.
At dinner, we ended up talking to a very friendly family of South Africans who were on vacation, and a couple people our age who had been there already for a day or two. They had suggestions on which “game viewing” activities to do. We had chosen the two-hour drive; other options included walking (which, obviously, won’t let you see as much of the park as quickly), a boat, and a canoe ride. One guy from the UK highly recommended the canoe tour, which sounded pretty interesting, because you can get pretty close to the hippos and other animals without disturbing them terribly. After eating, we were getting ready to walk back to the dorm when a group of three girls asked if we would walk them back. (It was dark and we had a lantern.) They turned out to be somewhat drunk, or at least one of them was, and were also staying in the dorm. We talked to them for a bit once we’d gotten inside, and it turns out they’re midwifery students from Holland. They also had to leave to be working in Mangochi by Monday! They told us where they were staying — in the dorm at the med school — and recommended we try and get rooms there.
The next morning, we got up nice and early, tried not to wake the Dutch girls, and headed up to the main lodge for coffee before starting off. At six, we were in the vehicle and ready to go. I don’t know how to explain the vehicle, exactly. Technically, it’s a Land Rover, but it’s more like a pickup truck with seats put up high in the truck bed, so you’re in the open and can see stuff. Anyhow, we drove down to where we’d walked the night before and saw more waterbuck and impalas running around. A few more minutes up the road and we caught up to another vehicle in front of us, which was stopped to watch a herd of elephants off to one side. There were about thirty of them, and they crossed the road in front of us. Most of them were pretty quiet and graceful and whatever, but a couple stopped to pose for the camera, so to speak. One bull elephant got kinda annoyed at us for one reason or another and started headbutting a tree. It was about thirty metres away at this point, and our driver looked pretty uncomfortable. Of course, the vehicle chose this particular moment to refuse to start, so we were stuck anyway, until a few volunteers jumped out to push-start it. Guess who? :P
Anyway, we followed the elephants a bit, then got back on the road pretty quickly. We saw a bunch of random animals, like guinea fowl and baboons. (Not that baboons aren’t cool, it’s just that we see them everywhere. All the national parks in Malawi have them, even Lake Malawi national park, which technically is just supposed to protect the fish!) We also saw kudu (more antelopey things) and warthogs, including some baby warthogs. We also drove past some buffalo poop, which looked fresh (supposedly), and then came across some buffalo footprints (also fresh), but didn’t see the buffalo on the way out or the way back until the very end. We actually drove past the lodge and completely off the road to get closer to the buffalo, which made our two-hour drive closer to two-and-a-half, but nobody was going to complain! Breakfast was ready for us by the time we got back, and we all sat and discussed what we’d seen. We were a bit disappointed at not seeing any hippos, because the drive didn’t go that close to the water. By this time it was too late anyways, the hippos would all be in the water. (They sleep on land and stay in the water during the daytime.) At the random guy’s recommendation, we tried to get on the canoe trip, but all the boat and canoe tours were booked for the whole day. Then we found out somebody else was getting a lift into town, and we decided to take off and try to see if we could get a boat tour elsewhere in town. We already knew there was a hotel called the Hippo View Lodge that offered ridiculously expensive trips, so we decided to check with them.
Did we get to see hippos? Well, you’ll just have to wait until tomorrow to find out!
It’s a good thing we did stopped at the Hippo View lodge. First off, our ride was stopping close to there, so it was easy to get to. Secondly, after complaining about the price for one- and two-hour cruises, the guy mentioned they do half-hour trips as well. It was still a bit pricy, but the guy (”captain”?) said we’d definitely see hippos in that thirty minutes, so we agreed. (I should explain — you pay for the whole 12-seater boat, so it’s cheaper when you have more than two or three people.) He needed to go check something, so he wandered off for a few minutes. When he came back, he had a white woman following behind him. Apparently she’d wanted to do it as well, but found it out of her price range, but was interested in chipping in together. With her and her husband, we could all get an hour for the same price, so we did. We also discovered that she’s Canadian, from Vancouver, but works in Malawi doing something with mother-to-child HIV transmission… presumably reducing it?
It was a nice scenic boat ride — there were baobab trees everywhere, and fishermen in dugout canoes around us. After ten or fifteen minutes, we saw a few hippos. Of course, when hippos are in the water, you’re really only seeing eyes and ears, but it was still cool. They have such neat ears — they can turn around and flip them and all sorts of things. After stopping and going a couple times to see a couple different groups of hippos, we spotted two who were out of the water and eating. This is fairly uncommon to see at eleven in the morning. We got our pictures, and kept going. By this point we were well inside Liwonde National Park, so when we saw a canoe full of people, we weren’t too surprised when a few of them recognized us and waved. We saw more hippos, including one doing that famous hippo yawning mouth wide open thing, and then headed back to the Hippo View.
We only had to walk a couple blocks to get to the police traffic block, which is where the minibuses stop to pick people up. Because of the way that the “bus routes” go, we had to go to Mangochi, then catch another bus to Cape Macclear. It didn’t take long to get a bus to Mangochi — it seems to be the transport hub of the area — and it was a short ride. From there, we had to walk a few blocks through the market to where the buses leave from. None of the buses waiting said “Cape Macclear” or “Monkey Bay” (the town where you have to switch buses again) on them, but as soon as Chisoni mentioned we were going that way, suddenly people started filling into minibuses and we were ready to go.
Lots of people kept getting on and off at very random, middle-of-nowhere places, and after a little while we reached a small town. The bus stopped, a few people got off, and the driver got out and headed towards some people who were selling food. For the first few minutes, we just figured he was getting lunch or something. I was hungry, so I got out and got some chips and a drink. (Chips in the British sense of fried potatoes, that is. They have these cool roadside barbecue things… although nobody says barbecue, they say “brai”, which is South African.) Anyway, Mark and Chisoni followed shortly thereafter, and then Chisoni found out that the minibus had just decided not to go any further that day. Apparently there were only three of us and that wasn’t enough to pay for it. (Never mind that everybody had already paid, regardless of where they get off, or that there were actually five of us continuing on!)
How did we continue on, you ask? Well, we obviously weren’t stranded indefinitely, but for more details, check back tomorrow.
After our minibus decided to stop driving, the details became fuzzy, but somehow they’d arranged for us to get a ride with someone else, so we did that. That someone else, though, was a pickup truck, so we jumped in the back. Like I said, this was a fairly small town, and we were driving through what was basically the middle of nowhere. This, of course, meant that a couple of mazungus riding like regular people in the back of a truck was a very odd sight, and we got a lot of staring, yelling, waving, and the like. A couple fellow drivers even shouted hello or gave us a thumbs up. Children seemed particularly interested, and most of them waved. This is something that happened a lot in Tanzania, kids waving at white people driving by, but almost never seems to happen here in Malawi. We were in the back with a woman and her kid, who had been on the minibus with us, as well as a couple men and an old woman, who presumably were there before us. (Chisoni, our guide, was in the back with us until later, when he moved into one of the front seats.) As we were driving, if people were standing by the roadside, the driver would honk, and if they wanted on, they’d wave, and the truck would slow down or stop (yes, people tried and managed to jump in the back of a moving pickup) so they could get on. Oh, and in case you’re thinking “isn’t it illegal to be in the back of a pickup” or “you didn’t have seatbelts” or anything along those lines, relax — everyone here does this, including the police! Anyway, some way down the road, we’d managed to accumulate ten people and all their associated luggage and packages. A couple of them, upon noticing I had a camera, asked me to take their picture. (Well, one gestured towards my camera and then herself; the other one asked, in broken English, if I could “flash him”!) Then we stopped for two men who had a ton of stuff with them. After making half the passengers get out, we loaded (Mark and I helped arrange things) about 300kgs of sugar, flour, maize, and anything else that’s white, powdery, messy, and edible. Then all twelve of us got in and kept rolling down the road.
Now, I should add that there’s a pretty big highway up to Monkey Bay, but it’s being redone. This means that most of it is perfectly fine, but there are sections where you have to get off and drive on the shoulder (which is the old road, and is somewhere between one and six feet lower) for a while. Anyway, on one of these transition places, we managed to get a flat, so the truck stopped, we all got out, and they managed to jack it up, put the spare on, and get ready to go. Spare tires in Malawi seem to just be an extra tire; it’s not like those little tiny North American spare tires that are only supposed to go ten kilometers or something ridiculous. Anyway, since there were new two people waiting to get on, we put them (and their giant boxes that smelled like a bad combination of fish and wet garbage) on the back… so that made fourteen people (seventeen, if you include those who were riding in the cab) that eventually rolled into Monkey Bay, along with a few hundred kilos of associated baggage. Yes, this was a regular-sized pickup truck.
So at Monkey Bay, we got off at another gas station, gave Chisoni money to go buy a loaf of bread (he didn’t explain why we needed it until later), then hopped onto another, larger truck to ride the eighteen kilometers to Cape Maclear. The truck almost left as Chisoni was buying bread, but since the store didn’t have any, he got back in time. There were other white people on this truck, although they were all speaking Dutch to each other. Want to know how I can tell Dutch from German? Say hello to them — if they can speak English properly when they respond, they’re probably from Holland. There were two girls about our age, who turned out to be medical students as well, plus a random older guy and a girl aged somewhere in between. All in all, there were eighteen people, plus a smaller amount of sugar and whatnot, in this larger truck. Which was good, because the road was absolutely ridiculous. People in Cape Maclear joke that they have the best road in Malawi. Everybody, no matter how bad their English is, understands that it’s a sarcastic comment because there’s only the one road in and it’s terrible. It was 18km of hills, curves, and odd angles on the road. I no longer find it odd to be at twenty or thirty degrees from the vertical while driving.
One way or another, we all got to Cape Maclear. The village also only has one road, so the truck went down it and started dropping people at their hotels and whatever. Except we hadn’t pre-made any arrangements, so Chisoni randomly told us to get off when the Dutch girls did. They had a reservation, but were a day early, so we all had to find somewhere else; the place they had planned to stay was full but had friends down the road with a new place, so we went there instead.
More details on Cape Maclear tomorrow.
The place we found to stay in Cape Maclear was a campground run by what I can only describe as a crazy old hippie guy and his wife. He was white and sounded South African, she’s probably ten years younger and “coloured”. (Unlike back home, “coloured” means somebody’s of mixed race here… it’s also not a horribly insensitive term here either.) Both were very nice and enthusiastic, showing us all the facilities before trying to sell us on anything. The five of us (the Dutch girls too) took the dorm tent, which is basically a family-sized tent, one of those fancy deals with three “rooms” in it. The door faced the beach, and was maybe thirty feet from the lake. Shortly after putting our things down and using the washroom, the power went out. Most of the other tourists seemed to be fluttering around confused; it became really obvious who was a Malawian (real or honourary), as the curses of “stupid Escom” and “oh, you have load-sharing up here too” went around, while the tourists continued to look baffled. The rather small kitchen at the campground wasn’t in operation to start with, so she (the one owner) offered to fire up the brai and do some fish, or we could head down the road to a place called Timothy’s. We opted for Timothy’s. We had been warned that it was good and cheap but took forever, even when they have power. Considering how long it had been since we ate (if you count chips as lunch, then eight hours; if not, then closer to twelve) we weren’t too concerned about waiting. We ended up next to the “old” Dutch guy (he’s probably, like, late thirties) and talking to him for a while. Oddly enough, they didn’t have chambo, which is Malawi’s famous fish from the lake, so we ended up with some other form of fish that I later discovered was a catfish also from the lake. The power came back around the time we were looking to head back to the camp. Mark and I went to bed, as we’re used to going to bed around 9pm (we have to get up before 6am to be at work for 7am); Chisoni stayed up and, as it turns out, went to one of the big parties that was going on this weekend. One of the people who owns a couple of the beachfront resort/hotel/restaurant/bar things was celebrating the opening of his newest one… except it isn’t actually open, so it’s just an excuse for a party. I’d say it was nice falling asleep to the sound of the waves crashing onto the beach, but that was drowned out by the music from the lounge next door.
Waking up to the sounds of Lake Malawi was nice, though. We were all up and ready to go before 7am, and because of the ruckus the night before, the cook wasn’t up at our campsite yet. So, we started wandering around looking for somewhere that was open. Apparently, despite the fact that Malawians generally get up early, this hasn’t carried over to the restauranteurs who cater to tourists. We ended up buying some biscuits (cookies) and Sobo (”juice”, for lack of a better word… not real juice) and eating them on the beach while watching the people go by. The people, of course, were the actual people from the village who were doing laundry, dishes, fishing, fetching water, and so on. They were quite friendly, and the kids especially seemed baffled at why there were white people sitting where we were (which is basically off the beaten path) and why we were eating cookies for breakfast. This didn’t stop them from eating Mark’s leftover cookies, though! One guy, during the usual exchange of pleasantries, responded that he was “doing wicked awesome”… I wonder who taught him that? Everyone in Cape Maclear, even the kids, speaks really good English — kids who are too young to go to school can have a (short, simple) conversation with you. There are some volunteers who teach English in the village, and between that and the constant exposure to tourists and the language there, they pick it up pretty quickly. It’s really important to know it to get a good job around here, so they’re actually quite lucky to learn while they’re so young.
We walked along the beach back to our camp, where Chisoni had arranged for a boat to meet us and take us to the islands. There are a couple islands nearish the beach, and it’s a good place to swim and see the fish and that sort of thing. We were picked up, then we headed down a bit to pick up another lady from another hotel, then we had to pick up some supplies from a third place… eventually, we were off across to the island. It’s part of Lake Malawi National Park, according to the sign — and by sign, I mean the rock that had “Lake Malawi National Park” painted on it. We got our bread, ripped it into some smaller pieces, and started throwing them to attract the fish. Lake Malawi is famous for its cichlid fish, of which it has over 1500 species. The lake is absolutely full of them, especially in those shallow waters around the island (and off the shore near the beach, to a lesser degree), to the point that it’s said you can dip your hands in the lake and scoop out the fish. We tried to catch them with our hands and didn’t have much success; they were nipping at my fingers and toes (presumably because they look like little lumps of white bread) and I still couldn’t get them! They’d brought snorkels along for us, so we could swim around and get a really good look at them. It’s funny — they all look the same but different. There’s blue ones and green-blue ones and blue ones with brown stripes and blue with black stripes and gray with blue stripes and… you get the idea.
After a while, food was ready. While we were enjoying ourselves, the people who’d brought us were starting a fire and cooking rice and fish. Once we were sitting still, the lizards stopped hiding in the rocks and came out to sun. Did you know that lizards will eat rice, even coming close to people to do so? Well, neither did we, but apparently they will. They didn’t want any fish, though. The cichlids also liked rice, which came in handy once we’d run out of bread. Since we’d eaten, it felt very late, but when we got back in the boat, it was barely “half ten”, as they say here. (That’s their way of saying half past ten here.) The boat looped around the island a bit to where the fish eagles have a nest. The tour people threw some fish in the lake, and we watched the eagles swoop down and get it. Then we went across to “Otter Point”, where we didn’t see any otters, but we saw some rocks and a tiny island. The last stop was the actual National Park headquarters, where we got a brief tour of their exhibits and aquarium (which pales in comparison to the actual lake a few metres away). They also have a huge baobab tree that’s around 800 years old. David Livingstone, a famous missionary to Malawi, is said to have preached under it or something. There were also graves of a few missionaries with a little monument. After all this, we headed back to the campground.
Since we hadn’t known what time we’d be done all this, we hadn’t yet made arrangements to get back to Mangochi. This was, remember, one of the reasons we had a guide. Well, Chisoni managed to disappear somehow almost immediately after we got back. Mark and I went to get a drink, and ended up talking for quite a bit to one of the owners. Since they’ve only been open a few months, they’re very interested to see what people think of the place. Apparently they had a lot of difficulty with some of the contractors, so it looks almost nothing like what they’d envisioned. They didn’t even have an official opening; while the place was still under construction, they noticed a bunch of people camping out on the beach because everywhere else was full. Anyway, we mentioned we were going to be leaving for Mangochi, and she said “oh, some friends of ours are going there later tonight, let me check with them”. She did, and they said they didn’t mind driving us down if we’d pitch in for fuel. Considering we’d paid before to ride in the back of a crowded pickup truck, we were more than okay with this. A bit later, these friends returned from whereever they’d been — they’re people who spend quite a bit of time at the Cape and seem to know everyone at all the hotels, so they were making the rounds. They sat down to have a drink and chat, and midway through our talk, Chisoni shows up and interrupts, asking if a minibus has gone by yet. Half-glaring at him, we respond that our ride is sitting across the table from him, that we’ll be going back by private car directly to Mangochi. I’m pretty sure he didn’t get it though.
These people — two Malawian women (I’m assuming, they were African anyway) and a guy from Australia — had one more place to go visit, so they said we’d have about an hour if we wanted to wander the village. Chisoni took this as his cue to resume his guide responsibilities, so we went through the village away from the tourist traffic. Apparently not many white people do this, so almost everyone was looking and saying hello. Then we ran into a lot of people traffic because there had been a big meeting about government subsidies, so we decided to take a detour to the beach and walk back along the water. We asked a local for directions, which ended up leading us through a graveyard. It took us a while to realize it was a graveyard, though, because it was full of goats. Seriously, there were goats everywhere, standing on the little monument things, just hanging out and bleating a lot. We eventually got to the water, and it was a nice walk back. By this time, people were finishing up their day’s worth of fishing, straightening nets and setting fish out to dry and such. We got back, squished into car, and drove the couple hours back to Mangochi. Oh, and for an example of how bad the road is: that two-hour drive is actually only 56km!
During the drive, we learned that one of the women had been having eye problems and had actually been told that there were some specialists coming up from Blantyre and to go to the hospital on Monday morning! She told us of the accommodations that the College of Medicine had on the hospital grounds, and said that she thought visitors were usually allowed to stay for free. (She knew doctors were; students were iffy.) So, we got them to drop us off there and stick around while we checked with the security guards. They seemed satisfied with our explanation, although they said they’d have to check with their boss before officially waiving the hostel fees, so we said goodbye to our new friends and got settled in our rooms. I was very glad to finally be in a place with electricity, so I could recharge my camera — both batteries were more or less on empty after seeing all the animals at the National Park and all the stuff at the lake as well.
It’s been said that, if you want to get anywhere in Mangochi, you need a bicycle. Everyone rides bikes — mothers with babies on their backs, people with groceries, even businessmen in suits ride their bikes around town. There are also, of course, the bike taxis, who circle the town, mostly on the main streets and near the market, offering rides to anybody who looks like they might need one. There are so many people and so many bikes that quite often the only vehicles visible, even on the main road, are bicycles, with no cars, trucks, vans, or minibuses in sight. There’s even a big bridge over the Shire river, which runs through Mangochi, where I watched for a good couple minutes before anything other than a pedestrian or cyclist went by.
Now, these aren’t regular bikes we’re talking about, these are Malawian bikes. There is only one size of bike, so if you are a small child you must figure out another way of riding. (Hint: you can probably get your feet on the pedals without actually sitting on the seat, just put one leg under the crossbar.) There are, however, many different colours and shapes, as well as accessories. Bells and lights are among the most popular, plus of course the ubiquitous baskets, seats, and other ways of attaching good or people to the bike. A Malawian bike doesn’t need pedals so long as there’s something to put your feet on; the metal pieces that attach to the pedals are usually good enough to get a grip with flip-flops or bare feet. If this fails, you can always walk the bicycle, rather than actually riding it.
You do need to add extra metal at the back, though, to support the extra weight that you will be carrying. See, a bicycle is easily capable of carrying one person’s weight, but is usually able to handle the weight of two or three people, and this fact should be taken advantage of. For example, two people can fit on a bike, either in the bike-taxi arrangement, or in the less-traditional “hanging on for dear life because there’s no actual second seat” method. Alternately, a large load can be added, such as a 50kg sack of rice or flour, or several 5L jugs of oil strapped together. Extra-wide parcels, such as the jugs of oil or bundles of long sticks (including sugar cane, bamboo, or just plain ol’ firewood) are especially desirable, as they ensure you won’t be cut off by other dangerous cyclists. Some items are more challenging to transport by bicycle; this doesn’t mean it shouldn’t be attempted, it just means you’ll get more credit, and help whe needed, from those around you when you do. A live cow is among these difficult items that earn vast amounts of respect instantly.
One must remember that a bicycle is not just for riding, it is also a cheap and efficient cart. For example, it can be fully loaded (seat and all) with perhaps a hundred kilograms of wood, pushed to town like an ordinary cart, then emptied and ridden back home. Depending on the gears, you may have no choice but to disembark when travelling uphill, even when you’re the only passenger on board. Regardless, remember that you are a vehicle on the road, and thus have every right to shout at cars when they try to pass you. Also remember that, although you pay no taxes and in no way continue to the road’s upkeep, you have every right to pass other bicycles, even slow-moving cars and trucks, and cut them off as you see fit, ignoring any subsequent honking, shouting, or other distractions. You are also free to ride on whichever side of the road you see fit; although cars tend to stick to the left, you have the freedom to wander to the right, stop suddenly, or turn without any indication. If you are riding with friends, or make friends while travelling, you are welcome to ride three or four across, taking up the entire road in both directions, as necessary, so as to prevent the conversation from becoming interrupted.
And remember — when you’ve got a live cow on the back of your bike, you’d best have a plan for how to get it off when you stop without having the bicycle tip over completely… and hope you don’t have to stop before your final destination!
Well, I’ve been back for a week now, and I’ve definitely been experiencing some of the “reverse culture shock” that I’d been told to expect. Rather than putting words into coherent sentences and paragraphs, I’ll just list things below. I’m sure there’s a whole ton of other stuff, but these are the big ones that I wasn’t necessarily expecting.
- The Canadian flag is one of the most awesome things ever. Incidentally, the good people over at Yorkdale Mall have an enormous one that’s visible within a minute or two of leaving the airport.
- I thought something was wrong with the car on the way back from the airport; it was “too quiet”. Turns out that’s how cars sound when the road isn’t full of potholes.
- Going more than 100km/h doesn’t feel as dangerous when you’re inside a vehicle, wearing a seatbelt, and not worried about people or chickens running onto the road.
- Driving on the right side of the road isn’t that confusing, but being a pedestrian is. Turns out you have to look left then right here.
- There are an awful lot of white people here! On a related note, it takes me most of a conversation with a black person to realize that they’re black… usually I need to notice a white person in the background to remember I’m not in Africa.
- Hanging out with native English speakers makes life much, much easier.
- Buses are very, very empty comparatively.
- Credit cards are very useful.
- It’s nice ordering things from a menu and knowing the restaurant won’t mysteriously be out of key ingredients like chicken.
- Having electricity and water 24×7 is awesome! I have yet to take a disappointing shower; Africa was closer to a one-in-three success rate.
- Being able to communicate with patients is fantastic! So is being able to help them because they aren’t irreversibly blind!
- When you see a price tag for something, I can’t mentally divide by 140 anymore to get the real cost!