Wednesday, January 20, 2010

Are you a lion?

Yesterday, a man came up to me on the street and said "Why are you looking like a lion? Are you a lion?" I thought that was awesome.

Annelies' last days in Malawi!!!

1/20/10
Well our time here is winding down and the computer work is ratcheting up! So, Monday our UNICEF contact was out of the office, so we worked out of the hotel and made arrangements to visit St. Gabriel’s Hospital where they are using frontline SMS to do patient tracing. We god some of the process models done, so that was cool and worked on taking notes on the interviews that we did. The goal is to get as much as possible done here so we can avoid getting overwhelmed when we get back to the NYC. Yesterday we visited the hospital and met up with Isaac Holeman who was one of the CHAI team, we interviewed him on what is I think the longest running SMS program for health care in Malawi, and then headed back to Lilongwe for lunch. We ate really good pizza at Mamma Mia’s and I found a postcard for my sister in law’s kindergarten class which I should mail tomorrow. I also found a really cool book of East African folk tales I wanted to get for Claire, but as it was in the Old Town Mall I think it was priced for tourists at $15, a little above my price range, so I’ll see if I can find it on Amazon, but we’ll see. I think she’ll be fine without it though  So, let’s see, we hung out with Isaac and Marc Abbyad who works at the hospital, we made a playlist of our favorite songs and just hung out and talked about life and work and whatever came up, it was a lot of fun.
Today we went out for our follow up interviews and in detail process mapping at the Baylor project out in area 25 at a satellite health center, it’s a normal MOH health center, but each Wednesday the Baylor team comes out to do HIV/AIDs related care for antenatal care, PMTCT and Under 5 exposed children. So that was great, we got some great info and I got to play with a little baby who was waiting for a DBS test who made me miss Claire, but that’s okay, I’ll get to see my family soon. We went over the process model we built with Isaac (which I’m taking a break from revising to write this) Now we are just working on more paperwork and will go to dinner soon. It’s Annelies’ last night, so we have to go try a new place for dinner. I think we are headed out to Food Center, or something like that. So, That’s what we have been up to in a nutshell, I wish I could remember some of the funny things that have come up that I wanted to share, but of course as soon as I open up the blog, I have totally forgotten them.

Sunday, January 17, 2010

Lake Malawi... where I bought my new curio shop

1/17/10
Well it’s been a few days, I’ve been without internet for a while so let’s catch up. Friday was a national holiday so not too much could be done there. We went to the Queens hospital in Blantyre and met with one of the heads of the lab there to talk about their process and then headed out of town. We thought, it’s been a long week, we should go and check out Lake Malawi. So we had the UNICEF folks drop us off at the crossroads and hopped into a minibus headed for Salima, once we got there, we took a pickup to Senga Bay and checked in at Carolina Hotel. That night we decided to gofor a long walk down the beach to go check out Cool Runnings, another hotel, which we heard had the best burgers in Malawi. Unfortunately for us, we didn’t know that they only did dinner for people staying there (and they were fully booked) due to their small kitchen. I appealed to Sam, the owner, but se apologized and just said that there was no way to accommodate any extra diners. However, we soon got a message that the kitchen had extra chicken curry if we wanted it, so it all worked out in the end. We had someone call a taxi for us, but apparently the driver had been drinking so Sam took us herself, which was really nice of her. On the way she said if we wanted to come and eat there the next day, all we had to do was call in advance. So, it was time to sleep and we didn’t let the lizard poop on our beds deter us from getting some rest. Oh, I did accidently break the key off in the lock trying to free a deadbolt which had been stuck… oops. So the door to our room would no longer lock. My bad.
The next day I realized that I had completely depleted my cash reserves and was left with 610 Kwatcha in my pocket, which about $4, and headed to the nearest ATM which was in Salima. Along the way we dropped off Annelies and Michal at this really cool crafts market. I’m not sure exactly how this came to be, but there were nearly 50 stalls along the road, all of which had people doing all sorts of cool art. So, I joined them on the way back, and proceeded to buy a ton of gifts for family and friends back home. Annelies says I bought that whole market and that it looked like I was going to start a rival shop once we got back to Lilongwe. The cop who checked the trunk of the taxi today must have agreed because he asked if we had papers to transport all the stuff we bought, but he just laughed and let us pass when we said it was gifts to take home. Anyway, I’m jumping ahead. After the shopping, we went back to relax ant the hotel and read and nap and do all the other things that make me grateful for weekends. Then we headed back to Cool Runnings for dinner and afterwards met the most cynical lady… She didn’t like anything and was highly disapproving of everything that everyone does. So yeah, That lady wasn’t much fun but gave us something to laugh about on our way home. Oh, yeah, during the relaxing part I’d also talked the hotel folks to give me a new room, as the lock was broken and went to I think 3 rooms which had varying problems such as being completely devoid of furniture or lacking a working light before we finally got one that worked, though the fixture was a little broken so I couldn’t turn off the light without also turning off the fan. When I wanted to go to sleep, I ended up just removing the light bulb.
This morning just as we had packed up and got all our stuff ready to go and to the main building, the skies opened up. We had called our taxi man to take us to the main road where we were going to wait for a minibus, but we weren’t even sure the road was drivable for his old Toyota Carolla. Sure enough though, he showed up. Oh, and I should say, it wasn’t just raining… it was the type of rain where if you run to a car about 20 feet from cover, you are as wet as if you’d just hopped into a shower. We had discussed that maybe it wasn’t the best thing to stand out in said rain with all our stuff (including laptops) getting soaked so I bargained down the price to get all the way to Lilongwe down from 15,000 to only 11,000. As we headed to town I had to just put on my seatbelt and listen to music without thinking too much about it, because the rain for nearly all of the 120 km was so thick you could barely see past the hood of the car. We stopped a few times by the side of the road just because there was simply no way to drive in it. However, we eventually arrived safe and sound at Kiboko Hotel, our old friend which seems even better now with its clean rooms and fast internet, and just got settled in before watching Tenacious D and the Pick of Destiny on the satellite TV in the lounge, which was kind of a trip to see that… It rivals the time Labyrinth was on Ghanaian TV when I was in a pharmacy buying doxycycline. Okay, well, that’s it for me for now. Tomorrow we are headed to the UNICEF offices and will begin work on our process models. More then!

Thursday, January 14, 2010

I traded a pint of blood for a coke at the hospital today....

1/14
So it’s been a heck of a last few days so I’ll just try and fill you all in a little. Right now we have just come back to the hotel and are watching the news of the earthquake in Haiti. It’s just terrible. Of course as I’m in Malawi and I should probably tell you all about that.
So, yes, let’s see. Yesterday we went to the district hospital and looked into what the process there was for PMTCT, EID dried blood spot testing and how the patient tracing process is working right now. We interviewed the Senior HSA and followed the patients through the process. So, the DBS testing was the one with the most comprehensive follow up procedure. If the mothers don’t come back for the results, they have two people dedicated to go out and follow up with those mothers and tell them that they need to return for their results. So they go out with a motorcycle and trace every single one weekly. However, the PMTCT and exposed children follow-up isn’t happening at all. They don’t currently record the defaulters anywhere. However we interviewed the head of PMTCT (who had been travelling with us the entire time) and she said she would be the one in charge of compiling the lists and would be happy to start doing that. Luckily, the ministry has just distributed and the health facilities have started using them since the New Year, a new antenatal register which has 5 lines for each pregnant woman which makes it much much easier to see who has defaulted from the program. So this bodes very well for the follow up. The head PMTCT nurse said that if the communication system could be put into place, they would start trying to follow up on these patients as well.
After these meetings, we went for lunch at the place with the giant baobab again and then headed back to the hospital to conduct a focus group with the HSAs. We ended up with I think 10 people. 8 of which had mobile phones. The focus group went well and we gained a few when we send for sodas. Fanta = more people in your focus group. Okay, quick right now update… This CNN report is really really sad. I just can’t believe it. And… the TV keeps turning itself off. So, last night was good, very mellow. Just sort of took it easy.
This morning we headed out to Chiradzulu. We arrived at the beautiful new hospital and met with many of the administrators. They seemed to think the program we were doing research for sounded good, though they had a dedicated group of patient tracers funded by Médecines Sans Frontières who were stationed at both the hospital and each health center. But this is kind of a good thing, if it wasn’t something that someone was already doing, it’s either the most amazing new idea ever or a terrible idea that would never work. So, anyway, their program is working really well, which is a great sign for our program. So we went out to a health center, and as is our normal scheme, Annalies and Michal went to go follow the antenatal procedure and I went to go and interview HSAs. I interviewed the senior HSA and one other one as well. After that we went out to another health clinic where Annalies and Michal interviewed the head PMTCT nurse and I interview two HSAs. Sorry NYC team, we have a lot of transcription to upload. So, after that we headed back to the hospital to check out the lab and I had read last week that Malawi was completely out of blood in the hospitals. It was the daily headline and people in the hospitals were dying from lack of blood. So I told the matron that I would donate and they traded me a coke for a pint of my blood. I’ll post photos soon. I think that they were not so used to people just donating though, as they were a little confused at the lab as to what exactly I wanted to do and took my information down on a quarter sheet of blank paper. They also had trouble finding a vein, the arm that is totally tattooed wasn’t any help for them, but they decided to give my deep veins a shot on the other arm and got the needle in and blood out. After that we headed back to the hotel and now I’m here writing to you all. Tomorrow we have an appointment at 7am with the hospital that does the PCR testing to see how that is done and then we are off to somewhere else. I’m going to try and be up at 4:30 to catch the sunrise in the morning and I’ll post pics if I manage. Last time I was up at 5:20 but the sun had beaten me. Okay, goodnight everyone!
P.S. Going to watch Malawi play the Africa’s Cup game… they won a huge upset last time so this should be fun!

Monday, January 11, 2010

Best... Place... Ever!

1/11/10
So right now from where we are staying up on a hill we can hear all the people celebrating the Malawian football team’s win (3-0) in the Africa’s Cup. Horns are honking, people are cheering, and it’s pretty cool. What else is pretty cool is the place we are staying, the Hostellerie de France (http://www.hostellerie-de-france.com/index.php) Wow, for what we paid last night we are staying in the nicest place I have ever stayed in Africa. We don’t talk about last night. That hotel sucked. But this place, wow. This is certainly recommended for anyone travelling here.
So last night we arrived in Blantyre with our UNICEF driver, oh I should also mention that we had met up with Issac and lucky from FrontlineSMS and Tim from The Clinton Global Health Initiative. They are super cool , I already miss them. It’s great to meet people, hang out for a day or two and feel like you have known them for months. We were talking about maybe trying to head back out to Liwonde National Park on Friday evening and staying at the park Friday and Saturday before heading back to Lilongwe on Sunday.
So, we took off from the Clinton Offices in Liwonde on Sunday afternoon and arrived on Sunday night. The place that had been recommended other than this one was all booked up for the next two weeks and we didn’t have internet to find contact info for this place (though it ended up being right next door to the first place we saw) we checked out many other hotels in the area and they were either total crap for the price or more than $100 per night, oh and one place had totally closed. Not exactly within our budget. So we eventually went back to some terrible place and paid too much for one night, looked up the phone numbers for this place in the phone book and were happy in the morning to see that crappy hotel in our rear view mirror. We went to Chikwawa district and met with the District Health Officer at the hospital who gave us the go ahead as well as well as his district PMTCT officer. Then we all crammed into the UNICEF car and headed off to a health center a ways out.
When we arrived we spent a small amount of time with the clinician, explained what we were there to do and let him get back to his patients (of which there were many). We met with a Health Surveillance Assistant, his name escapes me but I have it written down, and the clinic head for PMCTC, got a good overview of the program there, and then Annalies and Michael followed one expecting couple who had just come in for the first time through their entire first visit and then I went off to interview our HAS who also happened to be the HIV/AIDS counselor for the clinic. He gave us a lot of good information and we are headed out to his village tomorrow afternoon to see how things go in the villages. There is a village Health Council and I think he is also setting up a meeting with them. All in all it was a very good visit and I feel very good about where we are in the project. Afterwards we came back to town, I got into contact with this place and we were pretty darn sure that we wanted the two bedroom apartment room with the kitchen, so the UNICEF people Elsie and I can’t remember the driver’s name, took us to the People’s Supermarket and we stocked up on some food to fix. I am making an avocado salad tonight and pasta with an eggplant sauce. So, we arrived here and wow, this place is phenomenal, this may be the all around nicest place I have ever stayed. When we checked in, Charlie (the man who seems to be somewhat in charge here) told us that they had another visitor from the US and pointed out his card, he is from the business school at Columbia. It’s a small world, no? We then met the proprietor who bought us a round of beers and I got to practice my French. I went for a swim, and now I’m updating my blog as the sun is setting and will shortly head off to prepare dinner. So I hope all is well back home and I’ll write more tomorrow.

Sunday, January 10, 2010

Okay, one more time!

So yeah, it was a lot of fun and super relaxing, I would very much recommend checking it out if you are ever in Malawi and way way more affordable than any of the safaris based out of Lilongwe, it was I think about $18 to stay the night there and they would come out and pick you up and drop you back off in town for free. So yeah, certainly recommended. The ride in was like a little safari with the guy who does the driving safaris taking us, he told us a lot about the birds and other animals that we'd seen. I would have liked to do a safari during the morning, but after getting to bed so late, it just wasn't in the cards. Maybe next time. The canoe safari sounded really cool. I've never seen wild Hippos and I hear they are mean, but yeah, still sounds really cool. Ummmmm, lets see. I tired to text Katie like 50 times last night, but it never went through, though at like 3 am I got a message from her and finally managed to get one out after that. Ah the joys of the bush! Not too much else to report right now. I think I'll have good internet at Blantyre, so that should be cool. Okay, Hasta folks!
Love,
Casey

Back in Liwonde!

Well, our night out in the bush was pretty cool, we got out to the park right around sunset and I saw Impala (for the first time!) and a type of hornbill that only lays one egg every 9 years. There are only about 1,000 left in the wild and they won't breed in captivity. I'll post photos soon of all these cool animals. waterbuck too. then we got the the site, had the best dinner I've had in Malawi and some drinks and sat around the campfire till 4am. I also saw more stars than I have ever seen before. I think, it's been a while since northern Ghana, but this might have been even more than that. There is no electricity out at Chinguni Lodge, and it's awesome. There is an honor system bar, really cool South African hippies run the place. I hope I can take Katie and Claire there if we end up in Malawi this summer, I think that Katie would really like it.

We Got back into town a while ago, and are now just waiting for the UNICEF driver and program officer to come and pick us up to take us to Blaintyre. Okay, more in a sec, I have to change.

-Casey