I am sitting on a tiled terrace at my lodge looking surrounded by lush green foliage and the sounds of insects. The flies seem inescapable but at least don't bite. In front of me are the idyllic valley and hills of Blantyre, Malawi, a former Scottish colony and a small city of about 400,000 people. This rainy season has been one of the worst for years (I think I bring extreme weather with me... Switzerland, Toronto, Malawi...) and there are large swathes of wounds of red earth amongst the promising green where houses of brick and sand have collapsed. The valley has been flooded in some areas, displacing 40,000 people by one estimate, and killing others. My colleague here in family practice sees trauma from collapsed houses daily now.
Life is never as it seems. Even in "rich" places like my walled in, guarded lodge, power was out off and on over the last few days finally to return late last evening. In our bubble of privilege we can complain about eating cold food, swatting away constant flies, the increase in mosquitoes, and not being able to work effectively, but of course in perspective our troubles are miniscule. I seem to feel that constantly thinking outside my bubble is depressing, however, and sometimes it's okay to stay inside as long as one has a background paradigm of the reality of the land.
My introduction to Africa came through a semester abroad in the American University of Cairo. Most here, however, feel that doesn't even represent the status of subsaharan Africa and I agree though there are many similarities which make life here familiar to me. Expectations before I came: a much slower pace, an ability to get about 50-75% done of any tasks, more dirt, rain, and flies, and lots of poverty and extreme illness. All of the above prove true here in Malawi, one of the poorest countries in the world ranking 160th out of 182 countries on the Human Development Index. Read this short and accurate portrayal of Malawi's limitations here: http://www.ruralpovertyportal.org/country/home/tags/malawi.
Perhaps some of you wonder what I am doing here. As a second year trainee in my pediatric specialization of intestinal and liver disease (Pediatric Gastroenterology, Hepatology, and Nutrition) in Toronto, my studies now concentrate on a mix of gastroenterology and Global Child Health. the goal: to learn about and add to knowledge on the intestinal involvement of severe acute malnutrition, ie the swollen belly rusty haired kids you see on ads for child sponsorship. My mentor sent me here to a large public hospital in Blantyre, Malawi during the most voluminous season of the year to learn firsthand about what happens with malnutrition and how to take care of it medically in a site that he is very familiar with. Hopefully I will learn as much as possible about malnutrition in vivo and understand the gaps in our knowledge (huge huge gaps) in order to make some contribution to improved treatment. The hospital is huge and chaotic but offers decent care; in contrast, some of my days here will take me to the outpatient (not hospital) check ins of the less sick kids and if I can wing it, to a village at some point for at least a weekend.
Malawi is a country of corn. Driving in from the airport after three legs and two delays, one is faced by rows and rows of growing maize. Unsurprisingly, the default food here is Nsima, a mash of maize powder with very little nutrition. Cassava (a very common African food), beans, and eggs form the next levels of nutrition followed by rice, chicken, and beef or goat meat. Vegetables are abundant in this fertile land and imports from South Africa make their way into the homes of the rich. Most of my patients so far eat nothing or Nsima only. Most of the country is stuck in farming and dependent on the harvest much like the farmers of Egypt depended on the capricious floods of the Nile for their annual well-being (pre construction of the Aswan Dam which freed Egypt from such dependence while forcibly displacing many Nubians from their ancestral lands and flooding additional archeological sites). Mechanization is rare and the many trees that fell in the recent rains are broken down by a rusty machete.
The poor in the city and countryside as far as I can tell live in houses of mud and thatch, the lower middle class in houses of brick and sand, and the upper middle class in houses of concrete grouting and floor. Most permanent "muzungu" and the very rich live in walled in guarded compounds with large spacious houses on huge plots of land with their own generators for the frequent outages. Guards/doormen (boab in Egypt), cooks and maids are common as labor is cheap. Education is limited especially for those living in the villages or with less money in the cities and women marry and have children early. The people are mostly Christian - majority Protestant followed by Catholic and other minorities such as Seventh Day Adventists, Baptists, and Islam. (More on religion in Malawi here: http://www.friendsofmalawi.org/learn_about_malawi/culture/religion.html). Here in Blantyre most resemble each other with heart shaped faces, soft dark skin, small noses with flat bridges and generally medium to short stature. The women cut their hair very short and if they have money get weaves, cornrows, and other more expensive treatment. Legs are considered erotic here and are covered by skirts or long traditional beautiful rectangular pieces of fabric called a Chilungu which are used for everything from clothing to carrying babies to washing up while women breastfeed freely with not a flicker of an eye; the more curvy lower halves of women here probably led to that reverse to most "western" ideals of beauty. As to diversity, there are a few South Asian and South African/Tanzanian/Zimbabwean/other neighbouring country residents of multiple generations as well who I assume are only in the cities. Many many mzungu come here from around the world working with development and medical organizations. The hospital I work in now seems to have more visiting foreign residents than Malawian residents. From former Scottish colonization, English is the official language (using UK terms like "football pitch" for a soccer field) followed by Chichewa and multiple other regional dialects and shortbread finds its place in the supermarket biscuit aisle. My patients rarely speak English and the English of the nurses l inflected with different tones that are difficult for the untrained ear. In fact there is so much variety in how people speak English that I'm not sure I will be accustomed to it before I leave.
up next... more on the medical side of life
