Notes on a Medical? Life: Week Four Plus Malawi

Exhausted. Here are some random vignettes:

Bring Your Problems to the Mzungu

legit:

Doctor, my leg is swollen. Bambo (father), you have fasciitis and need to go to the hospital. Okay, doctor, maybe next week.

Hello, mother, does your child have diarrhea? Yes. Have you seen any worms in the stool? Yes, there is something in the placenta causing the pain. (I think that was a translator slip for umbilical cord??? What am I to think)

Server in a small restaurant

“Madam, I have a problem.”

My brother died late last year. He had an accident with a crocodile. Now his seven children are living with my parents and I want to take the children to private school. No, the public school is very far. No, it isn’t safe to walk. Their mother is there but I keep telling them the kids need good school and they don’t understand. I don’t know what to do. I make 9000 kwacha (less than $20 US) a month and am married with two kids to take care of. Yes, maybe I could bring one at a time here to Nsenje to go to the public school here. What can I do?“

Elderly woman on the porch in front of a general/grocery store

“Hungry, hungry!”

Disheveled middle-aged man walking on the street

“Madam, hungry, madam, food?”

not so legit

children (almost always boys) on the street seeing “mzungu” or white people immediately shouting

“Mzungu, give me my money!” to which I always reply “that’s not nice to say!” even if they don’t understand

youngish ?intoxicated man of normal muscle bulk in front of the restaurant asking for food from the middle of the street by making hand to mouth motions. This was, by contrast, after I saw a skeletal young man pass by, emaciated, dazed, and did not stop him to at least assess his status a little more. AIDS, newly orphaned, homeless? Hard to tell in this post-flood craziness.

Many here are fat, well nourished, well off from a nutritional standpoint. However after the recent floods, the camps are full of babies and children growing a new fuzz of the rust-colored hair of protein energy malnutrition, arm circumferences are shrinking, and bellies swelling. Adults exhibit the dazed look of the anemic and come with frequent complaints of headache, fatigue, dizziness. Judging by nail bed color, most Malawians are anemic at baseline augmented by attacks of malaria which infects and destroys blood cells, and unrelieved by a traditionally iron-poor diet.

Nsima, a corn flour staple of the diet here, is likely the only food for some. Others in camps have received air drops and vanfuls of peas, corn flour, and soya pieces. Depending on whether the supplies come to them or are illegally sold by the foremen, what part of the shipment they receive, and what parasites and other diseases are adding to their energy requirements, some have just barely missed florid malnutrition. Micronutrient deficiencies clearly continue. It is hard to know also what the underlying nutritional status of most of the currently homeless was before they lost their kitchens, money, and their farmland. Theoretically, farmers, as are most here, have a greater variety of foods especially fruits and vegetables than their metropolitan compatriots, however most meals across the country consist of a bowl or plate of Nsima, a porridge like to solid mash of boiled corn flour and water that definitely takes the place as Malawi’s national food. Nsima for the better off fills half a plate while a small undernourished chicken leg or goat or beef stew and vegetables fill up a quarter each. Nsima alone, nsima pulled off in blobs and dipped in a stew, nsima with more water scooped up with a spoon, … nsima nsima nsima. Interestingly, the corn-fueled exhibit better stamina than the rice-fueled, according to one South African business man who noticed that he had to frequently feed his rice-eating employees in order to maintain their energy throughout the day. With the nutritional content of deer feed versus the amino acids of rice, this surprises my nutritional brain. From personal experience, nsima feels heavier and keeps the stomach full longer… head to head it contains as much protein and more iron (though plant iron is not very well absorbed) than rice and more of some vitamins. Brown rice or enriched rice are a different story.

Greens of all kinds (mustard greens, rapeseed greens, collard greens, pea plant leaves…) are chopped and boiled and fancied up if possible with a helping of “groundnut” peanut flour. Boiled chopped cabbage, small green peppers, sauces of tomatoes and chili all make up some variety in the Malawian diet. Dessert seems to be a missing course but after a meal of 75-100% starch likely accompanied by a 35-45g sugar bottle of fanta or coke, who wants more sugar?

Fried potatoes (chipsi), junk food, and juice appear to be the treats of choice. Interestingly despite the corn there is a relative dearth of variety in corn use. Nsima, porridge, roasted corn cobs (more street food than home food), corn oil, and popcorn make their way to homes however corn bread, cornflour breading for fried chicken, roasted corn, and cobs for the home cook never make it.

Church

Amazingly, it is 4pm on a Sunday and in our quiet lodge, we are graced via loudspeaker transmission over the fields and small buildings over four hours of the raspy yelling of an impassioned preacher. Please stop. Catholic Mass this morning lasted over 2 hours with lots of singing from a young choreographed choir, young praise dancers in the front (dancing in unison no less), and multiple collections for each church of the parish. Another nondenominational pentecostal-like service I attended with a friend lasted over 4 hours of fervent if painfully voluminous speaker-aided praise and worship. Time seems to stand still and church services make up much the week if not the Sunday for the faithful.

Walking into a church full of Africans in front of images of a sandy blond blue-eyed Jesus unnerves me. I want to shout to the whole congregation “Jesus was likely Aramaic and definitely Jewish!! His skin was darker than mine!” Clearly the Scottish/Irish influence of imperialism permeated the culture with a western Jesus.

Of course not understanding more than three words also proves difficult. Even with the Mass somewhat memorized, I find it difficult to pray and gain spiritual nourishment. Fortunately Blantyre’s large expatriate population means English services available for the needy.

This week has been a blur of activity. The heat saps me from spilling out the details of my/our medical work. Today is a much needed day of rest (regardless of the raspy yelling of the scary preacher) and I’m determined to take some time to think not at all.