Wise Advice

Living Trees

We have had another very busy week on the hill. There is no doubt that it takes time to get the hang of the hospital, to begin to get to know people and be able to be more useful on the wards, people are starting to get used to us and us to them. One of my biggest difficulties is remembering who all the staff are and getting their names right, especially the women as just when I think I have got it a they dramatically change their hair do and I am at sea again. They are understandably quite hurt if you don’t recognise them.

 We were both working on the children’s ward at the start of this week and had the satisfaction of seeing two very ill children make good recoveries, however another child died during the night who we had not been so concerned about and we have no idea why. Charlie does suspect that it was over enthusiastic use of intravenous fluids, to rehydrate the child as there is a reluctance to use nasogastric feeding, which is much safer especially when they are unable to monitor fluids and electrolytes here. We were both very shocked and upset by that but hope that some equipment that is arriving this week may help prevent a similar thing happening again.  The incidence of diarrhoea and vomiting is increasing as we move into the rainy season and the number of children who are dehydrated will undoubtedly increase. The burettes are being brought out by three very adventurous student nurses from Queens University who are going to do a short elective study working in the hospital. We are really looking forward to their visit and to additional help in the hospital. We also hope that we can help them feel at home here and to learn as much as possible in their time here.

 It is frustrating to be working completely in the dark with some of the cases we see in the hospital each day, unable to get even very basic lab tests done. Charlie transferred 2 babies last week to Mzuzu, one who had a rare bowel obstruction caused by Hirschsprung’s disease and another child, whom we were very concerned for as he had come into hospital with a haemoglobin of 2!! was losing blood from his gut but we couldn’t find out why. The prognosis is very poor for him, but perhaps in a bigger hospital he has a chance. Being here a little longer means that we are beginning to see patients returning and recognising them. On Thursday we admitted a lady to the female ward that I had nursed near the start of our stay, she has AIDS and then developed TB, and was very poorly, she returned in a very weakened state but managed a smile and a” hello Sister Anna” which is how she referred to me. Charlie is on call this weekend, his last on call he says, having had two calls up to the hospital last night he realises he is getting too old for this, especially when he doesn’t know what is going to be expected of him or from what age range!!

This morning we experienced a mini tornado on the plateau, there had been thunder and an obvious storm over the hills but no rain, suddenly there was a fierce wind, and along our back-drive way we saw a twister of dust and debris moving through. Walking to church later I was able to see the devastation it had caused, with debris all over the road, trees up rooted and one house having completely lost its roof. Thankfully the occupants of the house were all safe. At the hospital Charlie had several patients who had been thrown over by the wind. Thankfully the storm has cleared, and we are enjoying a scorching hot day, resting in the shade of our balcony, and appreciating any little breeze.

 However, the twister cannot be blamed for all the tree devastation that is going on here up on the plateau. Despite the university having a department of forestry here on the plateau, the rate of de-forestation is alarming, and little evidence of trees being planted to replace them. Many of the Scots Pines, and Eucalyptus planted by Robert Laws and those that followed in his footsteps have been felled, some for timber and some for firewood, an ever constant demand as people still mostly cook on open fires.

We have visitors who arrived last week from Scotland who are involved in helping the Living Trees project that Johnny has started. A total of 20   primary schools and one secondary school will have tree nurseries which will be used to teach children about the importance of trees and the role they play in preventing destruction of their immediate and be a resource to replant some of the trees that have been felled. They are planting a selection of seedlings from cash crops such as rubber trees, macadamia nut trees and chillies, which will be sold to generate income for the communities and fruit trees to provide additional nutrition for the children. Finally, they are planting nitrogen fixing trees to improve the soil and reduce the need to buy fertilisers which the local people can ill afford. Irrigation systems, using solar power will help to ensure that the seedlings get sufficient water as well as providing clean water for the students. It is an ambitious plan but there is an urgent need, as the impact of de forestation is very real, dramatic erosion. a result of the rapid runoff of the rains is visible all around us. The vegetable garden has been very productive recently which has been fortunate as our visitors are vegan, so that has provided somewhat of a challenge to the catering department.

A Tree nursery at one of the primary schools.

As a slight break from the wards I have been attending the hospital women’s sewing group on a Wednesday morning. Lyn had asked me to bring out a sewing activity to do with the group, which was a little out of my comfort zone, however with the prompting of my Auntie Margaret and with help from several gifted ladies we designed a sewing kit. Ladies from my church at home kindly supported me in getting 20 of everything cut out and some preliminary sewing done for me to bring out in true “Blue Peter” style for the women to make as well as essential equipment to stock it so each woman has her own. They are now eagerly awaiting Rebecca’s visit as she is bringing 20 pairs of scissors to complete the kits. They have enthusiastically finished them, embroidering their names and personalising them with buttons and are now proudly bringing them each week to the group.  We have since been looking at the issue of trying to make re-usable sanitary pads for ladies, as these essentials are not available for most of the women. As even if they couldn’t afford them they are not available except in the towns. It makes life very difficult for women and results in many girls avoiding school when they have their periods. There is a national drive in Malawi to try to keep girls in school for longer, so it is a very topical issue. 

I have had fun doing research and development to see what materials are available locally.  I had a fascinating trip to the local markets in Mzuzu with a Malawian guide, who stopped me from getting lost, and was able to interpret for me as well as ensuring I wouldn’t be over charged. Eventually I found several flannelette sheets and other cotton materials to develop prototypes. There is such a maze of very low roofed stalls, selling all the second hand unwanted clothes, shoes and household fabrics from the UK and elsewhere which is all that most people can afford to wear I was very glad to have a guide and to eventually make it back out to sunshine and to be able to stand up straight again!. I have discovered a Malawian business that makes re-usables and is encouraging other groups to start up, so I am hoping to purchase their business plan and help the women consider taking on this challenge so that they could be sold both in the hospital and locally.

Later this week we are going to one of the most remote health centres on the lake shore, we get there by a long drive first and then a boat journey. The centre has recently been refurbished by a Norwegian church group and one nurse from the hospital lives there providing maternity and triage services for the community, who have no road access. It promises to be a very long day, but we might manage a swim to cool off at some stage! On Friday we are going for the weekend to

The sewing Group

One proud owner of a sewing kit, looking abit surprised!

Vwaza Marsh, a National Park that is beyond the mountains, and bordering with Zambia. We are staying close to a lake that is renowned for its bird life and also at this time of year where all the animals come to drink in the evening, so we are looking forward to seeing some game but have been warned that the mosquitos will be fierce!! Watch this space!

More photos of the effect of the tornado to follow shortly