The First Day at the Balaka Clinic

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  Balaka, Malawi
Tuesday, June 5, 2007

Today was the most exciting day of the trip thus far. The day began with a traditional Malawian breakfast which consisted of a tomato and onion fried egg omlet, chips (fries), muffins, and bananas. This large breakfast disappeared quickly and we began the journey to Balaka.  A 42 km distance exists between the Chilopora's home in Ntcheu and Balaka. According to Dr. Chilopora (Dr. C for sake of saving time because I am a lazy American and take the shortest route for everything), the drive takes 30-45 minutes depending on the market traffic. When traveling to Balaka on market days, many villagers are in the road and block the traffic. The drive took us 35 minutes today.
 
The clinic grounds are huge! The wall surrounding the compound, when finished, will have a total length of 450 meters. The shape of the lot is not square nor circular. It most closely resembles the shape of a hexagon. Construction on the wall has stopped at the government's request for some unknown reason. Thus, the wall is unfinished. Only the side of the wall running parallel to the road needs to be finished. Dr. C said that the wall would take a week to complete as soon as construction resumes.
 
I was very impressed with the condition and the quality of this clinic. This clinic was much larger, cleaner, and better organized than the clinic in Lilongwe. Regular maintenance was evident based upon the condition of both the interior and exterior of the building. Beautiful, clean ceramic tile comprised the floor of the hallways and reception areas. All of the rooms were kept tidy and well organized. Cleaning and general work around the clinic was performed by three maintenance men.
 
A 'grand tour' was given and we were escorted into Dr. C's office.  I was thrilled to find out that we would be sitting in on Dr. C's patients for the day. Today observed 12 different patients.
 
This experience was awesome! During each patient Dr. C would translate the symptoms and/or previous treatment while the screening was taking place. Most of Dr. C's patients fit into one of 4 classifications: Regular return patients, first time patients that are not referred, patients referred from other clinics and hospitals because of medicine shortages, and patients who come because of unsuccessful treatments at other clinics.
 
The first patient I observed was the most interesting of the day. SIDE NOTE: I have found it is very difficult to predict the age of Malawians. Whenever I speak of patients I will indicate a range in years based strictly on visual observations. The first patient was a young woman who was18-26 years old. I could write a book on my observations, but instead I'll keep it simple. She was diagnosed with a fungal infection in two areas of her body as well as malaria. The malaria would be treated with quinine. For the fungal infections metraonidazol was prescribed. It is also possible that the patient had HIV because the regions of her fungal infection were typical of HIV positive patients. Before an HIV test is ordered, the infections are treated first. This is to prevent patient anxiety. Treatment of the fungus will cause it to disappear within days. If it doesn't return than an HIV test is not needed. If the fungus returns an HIV test is the next action taken.
 
Today was awesome! I learned so much. There was much information to absorb. Aaron and I were two sponges who asked a mass of questions. I was writing furiously at all times. Altogether I saw 12 patients. A variety of ailments were observed including fungal infections, dyspepsia, skin rashes, malaria, TB, gonorrhea, Pelvic Inflammatory Disease, hypertension, and esophageal cancer. The cancer patient observation was particularly difficult because nothing can be done for her. Her condition requires a highly invasive surgery that, even if available, has a very low success rate. Cancer treatments are virtually non-existent Malawi. The expression of pain does not require you to speak. Suffering was evident in her desperate eyes and weathered face. To alleviate her discomfort medication was prescribed for pain. This was not an easy case to observe because this woman was similar in age to my grandmother, Emily Dewyer, who died of cancer recently (4/25/07). This was a grandmother as well.
 
I hope we have many more days like these and perhaps as the next few weeks progress, Aaron and I will be able to hear the problems of English-speaking patients on our own. Dr. C said that he sees many similar ailments repeatedly. Several weeks of observing will give me a grasp on the ailments people suffer from as well as the major symptoms caused by those aliments. Before long, perhaps I will be suggesting a diagnosis. Obviously this would be confirmed by Dr. C, but how cool would that be?
 
The drive home went quickly and we sat around the house until dinner. While we were sitting, a bat crept into the house and decided to crawl on the floor under my legs. At the time, my legs were propped up on a table. I was not overly alarmed by the presence of our visitor, but Aaron seemed a bit troubled. He decided to get his camera from the other room to take a picture of the animal. I kept reading and did not watch the intruder. When Aaron returned, the bat was no longer underneath my legs. He seemed highly concerned with the bat's whereabouts. As he was panning the area looking for the bat, he was surprised to find that the bat was about a 6 inches away from his feet. At the speed of light Aaron launched up onto the couch much like a cartoon elephant jumps from a mouse. Aaron's face was absolutely priceless. Nothing could say, "I have heard about bats and know the effects of rabies... so... I don't want it to bite me... someone please help," better than Aaron's face in that instant. The bat made its way outside and didn't acknowledge any of us. Cue the ridiculing. Naturally, I gave Aaron a very difficult time for his schoolgirl behavior. I had a good laugh and Aaron, being the good sport that he is, kindly tolerated the multitude of wise comments that freely flowed over the next few hours. Haha. The night ended with dinner which was the traditional Malawian maze dish.
 
I am finishing this entry in bed right now hoping that I will have internet access soon. As it looks, I will be posting 3 or 4 entries each time the internet is available so stay with me. The journey is still unfolding. More to come.

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