Routine

I think there starts to be a point when things feel normal.

This week that has happened for me.

I have always thought that I adjust to things rather quickly because of my lack of caring about routines.

But I seem to be in one already!

My weekdays go something like this.

Wake up around six.

Shower.

Feed the cat (the little shit will not leave me alone until I do).

Make breakfast, always toast and eggs.

Kind of do my hair (with out a blow dryer or straighter not much to do).

Put on mascara.

Walk out the door.

I walk about half a mile to the taxi stand.

Immediately when I get there somebody yells to ask if I am going to the hospital.

Well I do everyday.

So he yells at another cab to wait for me.

I get the the hospital, and head to wherever I am going that day.

I leave around four.

Then head to either the market, grocery store, or coffee den to use the internet.

I make sure to get home before five thirty when it gets dark.

Then I pretty much just eat and watch some tv on my laptop and fall asleep well before nine.

I am glad that I feel comfortable here.

But routine is not my thing!

I am getting a little bored. 

I will say I have not felt tired in weeks though, it is amazing!

I have only two more weeks left then I will be headed back to Mwaya.

I have already made a list of things I want to do in my free time there.

Hike the mountain, go snorkeling, find a crocodile, swim, run, and go to a soccer game!

I am also ready to be back with the group.

This week I have spent my time in the ICU.

Turns out monitors and vents do exist.

When I got to the unit there were two patients.

One was a teen who had eclampsia and had last her baby during childbirth.

The other was a man with a severe head injury.

The man was intubated.

Apparently his tube was clogged and the doctor quickly came in to change it out.

What?!?

People do things with urgency here?

Then he yelled something at the nurse.

An angry doctor and people stressed.

It felt like home.

So much so that I was not even phased by any of it.

Just grossed out by the amount of secretions an adult can produce.

I am learning more and more everyday why I am a peds nurse.

The rest of my time there was pretty boring.

Because there was actually quality care.

It was nice to see this side of health care here.

I am now moving onto the eye ward tomorrow.

I am way less than thrilled about this.

I do hope that we do at least see a lot of patients and keep busy!

I would say I am ready for the weekend, but I am not sure of any plans.

Last weekend was a pretty packed one.

Mike did come and we celebrated Fourth of July basically by eating hot dogs and wearing American t-shirts I found in the market and then going to the hotel and dancing in a dark sweaty room with a bunch of locals.

It was pretty fun, but we are lame and were in bed by midnight watching How I Met Your Mother.

The next day I went to Kande Beach for Hassan's (the guy I am staying with) birthday celebration.

The ride there and back was scary as shit!

I do not like driving 75mph next to people swerving around on their bikes,

children playing, and dogs running (yes a puppy was hit and not killed, I said we could not stop because I could not handle it. Hopefully it died fast or was just scared and not seriously mangled).

The beach was fun though!

It is fun and exhausting constantly meeting new people!

I did meet a girl who I really liked.

Of course she leaves in three weeks so we decided we cannot really be friends.

But we had a lot of fun anyway!

Once again I went to bed early, and the next day I found out a lot of people got angry drunk after I did.

I am glad I just saw the fun dancing part and then had a full eight hours of sleep.

It is already four thirty here.

So I guess I better wrap things up and head home for a night of dinner and tv.

Oh routine.

I am feeling very American today.

Yesterday was my final day in peds. 

It was a tough one.

When I had first arrived to the hospital I had been informed that a patient died.

It was a four year old girl with what they thought was Guillian-Barre Syndrome.

Since they do not have venilators they could not support her respiratory status.

I did not think that she ever looked that bad.

She was saying the day before, "I am fine, I am better."

So at least she did not suffer.

The worst part was that there was a dead kid in her bed with all of the other children and parents around to witness the whole thing.

I cannot imagine what those children are thinking!

Unfortunately it is not uncommon here so many of them are probably not too phased.

In the morning I went to the high dependency unit to see the new patient.

It was a little boy who they thought had severe anemia.

He was pretty much unresponsive.

We did a blood glucose and it was in the 20s.

The pushed dextrose and he began to cry and turn away from us.

Crying kids are always good!

They were preparing to transfue so I went to assist with the burns.

I gave lots of recommendations.

We used warm soapy water to clean the burns instead of clorahexadine.

And gave some pain meds!

The other nurse and I gave the surgeon lots of recommendations and he said he was happy we were there and he would try to change things.

Then I went back to check on the sick boy.

I was told there was no improvement.

He was not responding again.

Nobody was around or seemed to care.

I then had to play doctor.

I figured nothing was going to put the kid in a worse condition than he already was.

I told the nurse we needed to recheck his sugar.

Once again it was low.

So we pushed the dextrose.

I checked pulses.

Yeah I could not find any.

I told him then to run a fluid bolus.

We did, there were finally some faint pulses.

I tried to get a blood pressure, of course there was not one.

The nurse said he had to leave to go to his meeting.

I asked if they bag or do CPR if kids stop breathing.

He said yeah and pulled a bag out of a drawer for me.

Well thanks, I am sure it will be successful.

The kid's breathing got more shallow and I saw blood start to come out of his gastric tube.

I did not like being in there alone,

I went and got a nurse.

She said do not bag, there is still respirations.

My reply was yes, barely and there will not be for long.

She did not seemed concerned.

I told her to call a doctor.

The doctor did come and agreed that the kid was in septic shock.

We tried about all we could.

I was drained and there was not much improvement.

I decided that nothing I was going to do was going to help.

I think we were only prolonging the poor kid's life.

Which is not fair.

It is also not fair to waste meds and fluids on a child that has no hope.

I want to change this.

There needs to be better assessments and early intervention.

I will be working on this.

Today I was in the HIV/AIDS unit.

It was very well organized and stocked.

But a lot of clerical work.

The nurse was being very pushy and not very patient with me.

I am just tired of living in another culture today.

I am American.

I want to walk fast.

I want my personal space.

And I do not want to be shoved.

I do not want to listen to horrible African Christian music all the time (do they really have no more than ten songs???)

I also do not want to be the center of attention and talked to all the time.

I also do not want to hear honking cars every few minutes.

I am just annoyed today.

Luckily Mike is coming tomorrow and we are celebrating the fourth.

I got Jack Daniels, hot dogs, and lay's chips.

I am ready for a night off!

I think after this week it is very needed.

Happy 4th of July everyone!

Also this post I wrote yesterday.

But in true Malawian fashion the internet was not working so I could not post it! 

Also a side note the child did die yesterday I was told.

There really was nothing that could be done.

It is just so sad that it is the norm here.

Well I think I am going to try to take the weekend off from thinking about things and just relax.

I got pushy.

So Thursday I finished up my last day in the ER.

It was another day like the rest, except this time a family brought in a dead person.

I guess this happens often.

It takes time and money to reach the hospital so many people die on the way.

Thursday night Mike and I drank, I needed to drink after those few days.

We attempted to go out, but there is not much to do in Mzuzu.

So we mostly stayed in, I introduced him to Tech N9ne, and we watched "How I Met Your Mother."

Friday we took a cab back to Mwaya.

It felt so good to go home.

It is crazy how quickly a place can feel like home, I definitely am starting to feel at home there.

We had a pretty relaxed weekend.

Mike and I watched "The Lion King" and more "How I Met Your Mother."

I went on a seven mile run, laid on the beach, had some Tonga lessons (I suck), ate food, and drank sangria.

Come Sunday I was headed back to Mzuzu.

The bus ride back was interesting.

It was filled with obnoxious drunk men.

One kept shouting about me I assume, because every time he would shout they whole bus would look at me and laugh.

I was starting to get pretty pissed at him.

Luckily he got off the bus long before I did.

Alcoholism is a major problem in this country. 

People are often drunk at all times of day.

So nobody paid the guy any attention at all.

Monday morning I headed to the Chief Nurse's office to get my next assignment.

She told me I could go where ever I wanted as long as I got them all done.

Well you can just guess what I choose next. 

Peds.

I got to the peds ward there was another woman being shown around.

She is from England and here with an organization to be a clinical instructor.

I then got my tour.

There are essentially six rooms.

The nurses station and treatment room are in the middle.

Next to the nurses station is the burn room.

It is about the size of the treatment room at CMH and contains five beds.

Two of the other rooms which are about the size of two patient rooms put together contain eight beds each.

Then another two rooms which are a bit bigger contain about 14 beds each.

Where there is not a bed there is a mattress on the floor.

The mothers and patients share these beds (calling them beds is generous, they are the size of cribs).

I went to listen to report.

There is a doctor volunteering from the Philippines, his main focus is nursery.

He learned that a baby died in the night and he was very angry.

The baby had central cyanosis and they thought pneumonia so they started antibiotics.

The baby died about thirty minutes later.

I later asked if they have ventilators for any patients in the country, the answer was no.

If they need to they can intubate and the mother can bag.

I think that this does not happen, the baby just dies.

After report I followed the doctor to the High Dependency Unit.

It is basically their PICU.

There were three patients.

One was a kid with meningitis, he had been brought in so late that he could no longer function.

The other was a baby with an abdominal mass.

The third was a baby with now a repaired hernia that had caused an obstruction.

What interested me was the baby with the abdominal mass.

His stomach was so distended.

I noticed the mother was breastfeeding and the patient was not on any fluids.

I later noticed no patients are on fluids, there are also no monitors, and vital signs and assessments are non-existent.

The patient was put on oxygen due to increased difficulty breathing.

Since there are no sat monitors they just go off of clinical signs.

They have oxygen but it only goes up to two liters. 

And they only have that set up at certain places.

I told the nurse to ask if the patient was pooping or passing gas.

The mother said no.

I told the doctor that the mass or something has caused a bowel obstruction.

He agreed and let me put in an NG tube.

But there is no suction, so we had to let it drain by gravity.

I am sure that it was so thick it would not come out.

I asked about IV fluids and he said no it was not necessary because the patient was eating.

I told the doctor the patient should not be eating because he will end up perforating his bowel.

He did not really agree, but I told the nurse to tell the mother to stop feeding.

We then moved onto other patients.

As I was coming around the corner I saw a patient with severe hydrocephalus, it was a four month old and I would guess her head was the size of a volleyball.

Even her face started to look smashed in.

Then the surgery team started to round.

I got right in on this!

They saw many kids with abscesses, hernias, the hydrocephalus baby (which they asked if she had been to surgery yet, I wanted to say, "Do you see an incision dumbass? Because I do not." I decided this would not be appropriate.)

Then we got to the burns.

Talk about terrible.

I have never seen anything like it.

Four of these kids I would guess were at least thirty percent.

I did not see their backs.

They leave their burns open to air, not dressed.

I started asking about nutrition.

Turns out nobody is eating.

Well I got to educating everyone, including the surgeons.

He agreed to put NG tubes down two of them.

Turns out we do not have formula for them.

Did the nurses tell the parents to get any?

Nope.

Then it was time to administer meds.

The nurse calls out the patient's name and the mothers bring their sick kid up to the cart and we slam IV antibiotics in all of them.

Some kids are lucky enough to get either half a tab or a quarter tab of Tylenol.

I am not even sure how they mother's give it to them.

Many of the IV's were bad, and who knows for how long. 

I informed the nurse that they needed new ones.

She agreed and said she would do it after she finished passing meds.

In the afternoon it was slow.

I noticed that kids just lie in their beds and do nothing.

So I took some paper and made a ball, we played catch.

I also gave some kids pen and paper to draw with.

They were having a blast, they were more lively than I had seen any of the kids all day.

At the end of the day the doctor came back and was going to refer the patient with an abdominal mass to another hospital.

He thought that the patient could continue to eat and go by public transport.

I disagreed.

I said that he was for sure a bowel obstruction and should not be eating.

He argued that the patient has not been puking therefor is not a bowl obstruction.

I of course argued back, the patient is also not pooping or passing gas and his abdomen is huge.

He does not need to puke to be an obstruction.

We went back into see the patient.

There was some green output from the NG.

He then agreed the patient was also obstructed.

Well no shit.

I also pushed that we needed at least maintenance fluids to get him through the night.

He was reluctant because of being unaware of kidney function.

 I said yes but giving a very sick kid who has had an obstruction needs fluids, just to get him through the night.

He said he was nervous because night nurses could not manage fluids.

He finally found a syringe pump and said he was ok with it as long as it was run on a pump.

The largest syringe we could find was 30mls, the patient needed a rate of 36 ml/hr.

I knew the pump would beep all night and new fluids would not be started.

But I figured it was the same as not getting any fluids, what else could I do?

I had at least won one battle.

After that I called it a night and headed back.

I was so tired and drained I went straight to bed after going to the grocery store and to the market.

I knew that today was going to be another tough day.

When I got back today many of the patients were still the same as the day before.

I attended some morning rounds, many patients were getting discharged.

I visited my little ortho kids and gave them each a colored pencil and piece of paper.

Then I went to the nursery for a tour.

The babies were so tiny in their bassinets and the mothers all gathered on the floor waiting to breastfeed.

One mother was expressing milk by hand into a medicine cup to feed to her neonate.

It was so impressive to me that these mothers who just gave birth hours before were sitting on the floor.

Then I headed back for some burn treatments.

These kids with terrible burns get no pain medication at all.

They are debrided in their beds while all of the other children anticipate their turn.

It was heartbreaking.

This toddler who is not staff anxious screamed bloody murder at the sight of the gauze being opened. 

Since there was not much I could do, I did what I could.

I showed the mother how to hold the boy straddling her lap and put his face into her chest so he could not see.

I patted and talked to him (not that he could understand me), and held him the best that I could.

I was glad when it was over.

I only assisted with one treatment and then went to meet some of my fellow volunteers for lunch.

After lunch Kate a Ripple volunteer who is a retired doctor from Scotland came back to the hospital with me so she could see around.

The ortho kids proudly showed us their pictures, and we saw the other patients, and then I showed her the burns.

One dad asked me about his child.

He was wondering about debriding the outside layer of the skin off.

I had asked the surgeons the day earlier about surgical debridement.

They said it would bleed too much and they would have to wait until it sloughs off on its own.

I told the father this and then told him to talk to the surgeons.

He said ok, he just thought I was the one in charge of the burn unit.

This made me very sad.

I have only been in that room a couple of times.

I then asked him about the patient's nutrition. 

He said she was not eating much.

I told him she needs a lot of calories and protein, so things like eggs and peanut butter would be great.

I did see another parent later bring back a bag full of food.

I think that my education did some good.

It is amazing how little the medical staff talks with the parents here, it makes me sad.

Later in the afternoon I saw a doctor assessing a patient.

I went to see what the issue was.

It was a baby with severe pneumonia and a pleural effusion. 

Her respirations were extremely fast, but he had just turned up the oxygen and she was crying, so I was not too worried.

I listened to her, she did not sound too bad.

So I let her be.

I later went back to check on her, while she was sleeping I counted her respirations: 114.

I took her temp hoping she was febrile because this would be an explanation and an easy fix.

She was not.

I went and informed a nurse.

He said it was fine the patient had been seen by the doctor.

I said yes but the condition had not improved.

I asked if she was dehydrated, he said no, she was eating.

I told him this was dangerous but also knew that there was no other option really.

I did see the patient breastfeed and she did seem to be able to latch without struggle.

I am just afraid that when kids work that hard to breath they eventually just stop breathing.

I unfortunately know this from experience, fortunately though I learned this in a place where resources and help is plentiful. 

I am afraid this is not the case for this child. 

I am hoping for improvement overnight and that I am wrong in this case.

Being in peds is extremely hard.

But I also know this is exactly where I need to be.

I am sad that I only have one day left.

I think that when I am done with orientation I will be visiting the local hospital.

Kate has told me this place desperately needs my help.

I'm hoping I can be pushy enough to make some changes in practices and care.

As hard as it is, I am so amazed by the kids and the parents.

They are grateful.

Parents do not complain that nurses and doctors do not come see their kids, they are just grateful when they do.

They do not demand pain medication for treatments, they know their child is getting what he needs and they help hold.

They do no demand another nurse come try for an IV, they hold their child still and tell them to stop moving.

The kids may scream but most of them hold completely still, because they know they need to.

Parents have to stay and care for the children.

I think that some parents go get supplies or do washing and other parents watch their children.

I have not seen a single nurse responsible for a child. 

They know they have a responsibility, and that is their child. 

This is something I rarely see at home.

I think the hardest part of my job there is dealing with difficult families and bratty kids.

Here it is heartbreak, lack of supplies, and fighting to get anything done.

I am very interested to see what can be done and how staff will be receptive to new ideas.

There is a lot of work to be done and I am hoping that I can make a much needed change!

I am exhausted and need to head back to get some much needed sleep! 

I will leave you with pictures of the burns.

Just know that they are very graphic and not for everyone!

Life in the ER of Mzuzu Central Hospital

So I have started my orientation in the ER.

The last two days have been interesting to say the least.

I got to the ER and a nurse name Catherine was still on duty.

She had been working since 4:30 pm the day before, she did not get to leave until noon.

So she was not super friendly (I would have told and orientee to eff off so I did not blame her).

She told me to sit in the corner while she saw patients.

I did not want to be annoying so I did what I was told.

I am not even sure how to describe the ER.

There is one waiting room with benches around the wall.

An open treatment room, with stained room dividers, and stretchers which are rusted.

Everything needs to be cleaned and pretty much thrown in the trash.

But they make do with what they have.

I ended up being with Lawrence (or at least I think that is what his name is, every time I say it to people I get a different reaction.)

Lawrence is a clinical officer, he said there are health assistants, clinical officers, nurses, then doctors.

Well he is amazing.

He is very compassionate, intelligent, kind, and skilled.

I first walked into the treatment room and two people were on the table.

One man had stab wounds in his head and the other woman had been scalped in a biking accident.

I was called over to help wash the debris off of her skull.

I could not believe that she was not in an operating room, her laceration was equal to that of an FOA.

They were pretty much able to just pull the scalp down over her face.

Then they asked me to suture the stabbed man.

I said no I do not know how to suture.

I would need to watch more, I think at this point I have seen enough that I could successfully do it.

After those patients were seen we drained a lot of abscesses.

I helped hold a seven year old down for a huge abscess on his elbow.

I hate that I cannot talk to the kids, I feel that at home this is what I rely on.

I think that you empower a child so much by giving them little choices and telling them what to expect.

I have no idea if they did this with him or not.

I was shoving my boob in the poor kid's face to stop him from seeing because I thought it was freaking him out more.

The nurse finally said, he is saying he wants to see.

I felt really bad.

But it was drained and wrapped and he was sent out on his way, sobbing the whole time.

The afternoons always seem to be the worse.

We got a woman who came in on a stretcher.

She would not talk or cooperate.

She had a fever of 40.1.

I took her blood pressure, it was very low.

An IV was started and no blood would come back.

Lawrence thought he was against a valve.

I told him no, she was just so dehydrated that she would not bleed.

We desperately needed fluids.

Guess what?

We are out.

No fluids.

How the hell do you run an ER with no fluids?!

They said hopefully the wards would have a few bags and we sent her there as quick as possible.

Shortly after that a man came in.

He could not sit up.

His face was sunken and he was very short of breath.

His pulse was high, bp fine, but was shaking.

We suspected he was going into shock.

He was also extremely dehydrated and in dire need of fluids.

Once again there was nothing we could do.

Have I mentioned that Mzuzu Central Hospital is the highest level of care in the region?

He was suffering so much.

I hated that there was nothing I could do.

I just laid my hand on his shoulder and prayed.

What else can be done?

Today was not a super exciting day in the morning.

We had another stab victim.

More suturing.

I was basically falling asleep.

Then after lunch Lawrence said there is a lady with bad burns.

Yes they were bad.

I would estimate that she was at least 30-40 percent.

The burns were the result of a fire.

She was burnt on her face, chest, arms, and legs.

There was already eschar.

An outside hospital had done some debriding and wrapping and had also put in an EJ.

There was still so much more debriding to be done.

I got to work.

The poor woman had absolutely no pain medication.

She was so tough for the thirty minutes I worked on her.

I felt terrible, I could see that her husband had tears in his eyes, as did I.

There was still so much debriding that needed to be done.

But we just wrapped her and sent her off to a ward. 

Some of the things that shocked me are the lack of equipment and supplies.

I asked about a oxygen monitor.

He said they do not have one.

I also suspect there is no working oxygen.

I saw a portable suction machine, I am not confident it works.

I just cannot believe this is the highest level of care.

I really am hoping I never get sick here.

I am also impressed by the people.

Lawrence works hard and you can tell he cares.

I do not know how that is possible after seeing what he sees every day.

Also the patients are amazing.

There is never a complaint.

I am so used to dealing with angry, demanding parents at home, it is so strange that you can just leave a patient waiting in a room for countless hours and they will not complain.

They just wait.

The woman held her arm out for me to debride even though she is in agony.

The families all help, they feed patients, transport them, and do anything that is needed.

This is because they are grateful.

I'm back in the ER for one more day.

It will be interesting to see what tomorrow will bring.

It is not easy being in the learning role again, but I am doing my best.

It is also difficult to see so many people suffer without the help that is needed.

But I know this is why I came here.

I am constantly looking for a way to make a change.

Hopefully I will be somewhat successful after these two years.

Well I better head back and take off my only pair of pants I have to wear for these next four weeks.

The Blues Don't Match

Holy last week! 

I had to make notes to even know what to say, so much has happened!

Let us first begin with the bus ride journey.

So last Tuesday after getting the ok to start training I was headed to Mwaya.

I got my stuff all packed and waited on the porch waiting for my taxi.

A random driver came and asked if I was going to the bus station.

So I just got in.

Another girl was also going to the bus station, it turned out she was a previous RIPPLE volunteer.

I have never been so lucky!

Because I had no idea what the hell I was doing.

And Lauren was also getting on the same bus I was!

So off we went together.

We went to wait for the bus, I was so worried I would be late (I was a rookie to Africa still at this point).

No bus.

We waited for about an hour and a half.

During this time many buses came and went.

At one point Lauren went to go get some breakfast, as soon as she left I was sure a bus was going to run the bags over.

I started yelling for people to help me, they tried but obviously did not know what I was so distressed about.

Oh of course the bus was going to miss the bags by two inches.

I should have known this, it missed my ass by two inches just minutes earlier.

Well finally after waiting and many more people came, the bus had arrived.

Lauren and I had a plan.

I would get on the bus and get a seat while she would deal with the bags.

The funny things I have learned about the culture here is,

no they are never on time but when they get there, they will push and shove their way to get to where they are going.

Well I fought the best I could.

Of course some men had already grabbed our bags and got us a seat.

Bruised shins and a few hundred kwacha (for the helpers) we were off.

Or so I hoped.

The bus stalled four times just in the parking lot after we finally left at 10:30 (I arrived at the bus station at 7).

I almost cried, all I wanted to do was start moving.

Finally we did. 

The bus had every seat full, plus all the standing people that could fit, some chickens, dead fish, and much more.

It smelled great!

At least it was not too hot, I would have died.

Finally around 7pm I had made it to Mwaya.

I was greeted at the roadblock by an employee of RIPPLE.

The poor guy struggled with my one bag.

We walked a mile and a half with the luggage, I had to keep reminding myself I would only do this once.

Then I was finally there!

I ate dinner, had a couple of drinks, and then headed off to bed.

The next day I woke up around 6:15 and went for a run on the beach with Mike another volunteer.

It was so windy and not easy since I have not been running.

Also running barefoot in the sand gave me huge blisters.

I think my feet need some time to get tougher.

I'm looking forward to more morning runs though.

Then I headed off with Jimmy the preschool director.

He showed me around the many places that RIPPLE is involved in.

To get everywhere we cycle, I am learning to cycle in a skirt.

I keep hoping it does not get caught in the chain and leaves me half naked.

One of the places we went to was a preschool.

The kids of course were adorable, I was also very impressed with their English and counting skills.

I taught them, "I'm a Little Teapot."

They loved it!

Jimmy told me that I need to be a preschool teacher, I will definitely consider it!

I know this one is blurry, but I love the expression. What a sassy little thing.

I also went to primary and secondary schools and introduced myself to lots of students.

I guess there is some singer in Malawi who is also named Kendall.

So they all remember my name, I hear shouting every time I cycle past the schools now.

I went to health clinics, one which I was taken to on a motorcycle.

And also to the tree nursery where I was quizzed about every plant.

All along the way I met so many people!

I am definitely trying my best to learn names, as you can imagine it is not going super well.

I spent one morning in the Kande health clinic.

I did a little bit of wound care and then a lot of parachecks, this is the test they do for malaria.

Everyone I tested was positive.

I'm hoping my doxycycline does it's job!

I was overwhelmed by the lack of supplies.

There is no tape, no alcohol swabs, no paper towels, and I was told to only change my gloves after every five patients if they did not look dirty.
I spent another morning in the under five clinic.
We had to make quite the trek to get there.
I definitely should have worked on my mountain biking skills before I came.
I thought many times I was going to be flying over the handle bars.
The clinic was awesome.
The women all come with their little kids.
While they are waiting to be seen they sing.
The singing is so beautiful.
The women all holding their babies were just singing songs as powerfully as I have ever heard anyone sing.
I was given the job of weighing the babies.
We have a hanging scale and use the mother's wraps to hang the babies from it, or the older ones hold one.
Of course as many children would be, they were scared shitless of the white girl putting them on a hook.
It is a good thing screaming and flailing kids do not phase me.
We got done fast, I believe I weighed about 100 kids.
Some of the mothers at the end were being super pushy and grabbing the hook out of my hands and trying to put their sling on.
After holding so many kids covered in old pee (they do not usually have diapers) I was not having it.
I said in the voice all of my coworkers have heard, "hold on a minute."
They did not know what I said, but they laughed and knew what I meant, and it did the trick.

Friday night came, and we were all drinking and playing cards.
Mike and I decided to walk to Kande Beach.
He had told me about Kande many times.
So I agreed to go.
After the four mile walk we were finally there.
We played some foosball and drank.
Around two in the morning we sat on the beach deciding what we should do.
Four miles to walk back seemed like a very long way.
But I was cold so we started the journey back.
A couple of dogs that live at Kande started to follow us.
We thought no way will they come the whole way.
Mike thought when we cross the river they will turn back.
We crossed the river and I hear a loud splash and turned around, they had crossed with us.
They came all the way back to camp and apparently stayed there over night.
Susie, the volunteer manager is not a fan of dogs, and these dogs are very large.
Well they woke Mike up and made him walk them back.
He texted me to tell me he was going to just kill them so he did not have to walk all the way back again.
Yeah he lied and walked all the way back, apparently he picked up a couple of following children on the way.
Later that day the whole group went to Kande.
We watched rugby, ate, drank, ate, read poetry and a hilarious letter, drank, danced, and took lots of shots.
It was quite the night.
The next day some of us went to Mukuzi where we ate massive amounts of food and took naps on the beach.
That night we were all in bed by 7.

Monday morning Mike and I headed up to Mzuzu.
He needed to use the internet this week and I was starting training.
I got very lucky and met Hessen at Kande, he is a guy who has been living in Mzuzu for two years.
He has met a lot of the group before and he agreed to let me stay with him for free for the month.
I do not think I could get any luckier!
We headed off to the hospital, Mike very kindly dragged my bag and went with me everywhere.
The woman said that I could start as soon as I got a uniform.
I said, "Great! Where do I buy one?"
She replied, "You go to a tailor."
Me, "What?"
She showed me a photo of what Mike said were googled images of nurses and that is how they came to the conclusion of the uniform.
I needed a white top with navy pants and black leather shoes.
Luckily I have one pair of navy scrub pants.
So we set off with the badly colored photo copy of the uniform (which I was told to return!!!!!) and went searching.
Turns out white fabric is not easy to find.
I was ready to give up, but Mike would not let me.
We finally walked in a shop and they had a roll of white fabric, it pretty much felt like flag or banner material.
I said I did not care, we were getting it.
I also bought the blue fabric for the details, I knew it was not navy but I was over it.
So then we went to the tailor.
He took my measurements and told me to come back in three hours.
We went off to find shoes, I kept saying I did not care and just wanted a drink but Mike made me do it.
I broke the rules and bought little black tennis shoes, I did not want to wear leather.
Then we went off to A1 the Indian restaurant for some "snacks".
Well after we ordered four appetizers we waddled our way out of there and went to the tailor.
The material we gave him looked like a uniform!
I was impressed (I am no longer impressed though because I have worn the top for two days and my armpit has a massive hole and the bottom button popped off, I think he forgot to account for the fact that my ass is much larger than my middle).
We finally headed to where we were staying and I introduced Mike to "Girls."
After he demanded we watch the whole season, which equals six hours of tv, we went to bed.
I got in bed and Mike comes in and asks if I am going to get out my sleeping bag (there are no blankets).
I laughed and said I did not have one.
Well I froze half to death.
During the middle of the night I got in my bag and put on more clothes.
The next night I was more prepared.
I made Mike sleep in the bed while I took the mattress on the floor, to avoid the draft from the window.
I also layered all of my clothes and found sheets to put over me.
Oh that one is just a pillow case?
Well it went on my feet.

When I went back to the hospital the nursing officer was so shocked that I had a uniform made so quickly.
I asked if I looked ok.
She said, "The blues do not match." while laughing.
I texted Mike to tell him of our success, he said the blues not matching was the least of my problems.
Now I have finished my second day of ER orientation.
I am going to do another post on life in the ER, I do not think everyone wants to hear all of the gruesome stuff!

Sorry for the long and rambling post!
So much has happened!
I will be going back to Mwaya on Friday for the weekend.
If nothing else just to get a pillow and blanket!
I also think I can really repack my bags and enjoy the warmer weather.
I will be back to Mzuzu and be here for the next three weeks to finish up my orientation.
From what I have seen already it is going to be an interesting few weeks!

If anyone so wishes to send packages or letters I would be so happy!
My address is:
Ripple Africa
c/o Mwaya Beach
P.O Box 75
Chintheche
Nkhata Bay District
Malawi

My wish list for the clinics are:
tape,
alcohol swabs,
any dressing supplies,
bottles of sterile water or fluids (this may be too heavy),
children's medicine,
pretty much anything that can be sent would be used!

My wish list for myself is;
Girls Season 2 for my bday (Mike said this needed to be at the top of the list)
beef jerky,
tuna,
macaroni and cheese,
any magazines or books,
any snack items.

I do not really feel that I am lacking much yet,
being in Mzuzu we are eating out all the time and I am getting meat and cheese.
I know that this will change.
I do really miss Rosie and my bed.
My dad told me Rosie lies on the driveway a lot and he thinks she is waiting for me to come home.
This makes me very sad!
There are some challenges here but so many moments that outweigh all of the challenges.
I'm ready to feel like I have learned enough to start trying to make a difference.
I think that is the biggest challenge here.
There are so many ways I can help temporarily but how can I make things change for good?
It will be interesting to see how these two years turn out!

Making Friends is Beneficial and Mosquito Nets Only Worked When Closed

I have figured out how to get by around here.

You just latch to the people that know what they are doing!

Apparently there is a kitchen, grocery store, meat cookouts, and places to order take out from.

I learned this all from Naomi.

I believe that if you look free spirit up in the dictionary you will find Naomi's picture next to the definition.

So naturally I really like her.

Naomi is Swiss, but attended some high school in the states, and has spent a couple of years being a missionary in both Ukraine and in South Africa.

She is now working on getting her pilot's license, and looking to buy land to start a lodge for missionaries who are burnt out. 

To sum it up, she may be the coolest person I have ever met.

I had invited her to go to the futbol game with me and she agreed that it would be fun.

When we asked where the stadium was they told us it is not safe for two women to go without a man.

Of course no men wanted to go with us. 

So we walked to town instead.

 Then the boys that work at the camp (of course she has connections with everyone) picked us up and we went to the grocery store and got food for a cook-out.

We got vegetables to grill and while I was cutting them up I was talking to some locals.

They said I was a nice girl and gave me some of their fish!

It was delicious! 

The boys cooked meat and more meat.

We all ate and ate some more.

Then we all sat around while the guitar was played.

I headed off to bed early because I needed to wake up at 5:30 am to be at the nursing council first thing in the morning.

Well my room was full of a group from Holland.

So I proceeded to shower and get into bed by about nine. 

I do not think I fell asleep till 12, and it was very restless all night.

The person on the top bunk kept snoring, and his friend across from him was doing some weird throat clearing thing all night.

I was very close to beating somebody's ass.

So through all of my tossing and tuning I must have opened my mosquito net.

Yeah not good. 

I even have a bite on my eyelid. 

Good news is after 5 hours and 43,000 kwacha* later I am have a green light to start orientation!!!!

I told the cab driver to come get me at 6:30, in true African fashion he showed up at 6:50.

I was quite proud of myself for remembering to tell him earlier than needed.

We got in the car and were off.

Well kind of, the car did not sound quite right and he was not going very fast.

I kept telling myself when we break down I have at least given us extra time to get there.

He pulled up to the first gas station and got out and started running.

He ran back with a can of oil and popped the hood, put the oil in, and off we went.

I am not confident this fixed the issue.

But we made it, and I was literally the first person at the nursing council.

I waited outside her door for almost an hour.

Then she said she did not get my emails. 

I even sat there and emailed again from my phone.

Nope she did not get them.

Thankfully she allowed me to sign on and print off my documents on my own.

I thought I would be smart and also print off my CV, which I had forgotten about.

I quickly changed the dates, address, and phone numbers.

Twenty minutes or so later I realized there was no need to be quick.

She finally came back, took care of other people in front of me, and also got snippy with her coworker who I am assuming is new.

This made me feel a little better, I do not think she was ever mad at me she is just a woman that while doing business, she means business.

She then told me I had to pay 20,000 kwacha and go get passport photos taken.

Of course I did not know of the fee so I did not have enough kwacha.

So we went to the photo studio.

It was hilarious, I tried not to laugh the whole time I stood in line (this would not be culturally sensitive).

Every picture on the wall could have been featured on awkward family photos.

I wish I could have taken pictures for my coworkers (also would not have been culturally sensitive)!

My favorite was a picture of the studio workers, it was a huge banner.

On it were about 20 African men, most looking serious, some smiling, and some not looking at all.

The best part was the Asian man that was much larger than them all sticking out of the top.

I'm assuming that is Lee, it was called Lee's photo studio.

After getting my passport photos I headed back to Mabuya to get more kwacha.

Then it was back to the nursing council.

Oh yes, of course she just went into a meeting.

I paid my fees and then waited for another hour.

Finally she gave me my packet and said I would be doing my training in Mzuzu Central Hospital.

The cab driver then took me back to Mabuya.

I noticed smoke start coming out of the hood of the car, I was pretty happy the ride was successful.

I asked him how much for the cab he said, "Twenty three."

I said, "Twenty three what?"

He said, "Thousand."

I about shit my pants.

So whatever I paid him and am learning a very valuable lesson.

Always barter every individual ride.

He did spend a lot of time waiting for me today, but I am pretty sure I paid for his new engine. 

The breakdown of where I will be spending my days at Mzuzu Central Hospital for training are;

Under five clinic-2 days

Medical ward- 3 days

Surgical- 3 days

Pediatric ward- 3 days (Can't I just stay there the whole time?!)

Light House/ARV- 2 days (If anyone knows what this is, feel free to share.)

ICU- 2 days

Emergency- 2 days

I'm so excited to be doing something again! 

I miss working!

The only thing that is not good about this is the hospital is two and a half hours away from RIPPLE.

That means I will have to be paying to stay somewhere else for four weeks.

It is very stressful spending money while not having a way to earn money.

I am trying to have faith that it will work out just fine.

I tried to pay my hotel fee with my Visa tonight, all of the machines in town are down.

So I made a quick run to town to the ATM.

Well apparently you have to use an international ATM, 

I learned this after trying three then started to panic.

While walking down the street a local says, "Kendall!"

I cannot believe I am already known in this city.

It was a man who is a member of Mabuya Camp and comes here to hang out.

He took me around the market and showed me everything that is made here.

He is very friendly, maybe too friendly?

It is hard to tell when there is a cultural gap.

But I am definitely playing it safe.

He says he is coming tonight to tell me goodbye and that I need to come back to the city a lot during my stay here.

I will make sure that he and I are nowhere remotely alone together at anytime!

I guess I should go cook my dinner, shower, and repack all of my bags.

Tomorrow I have a lovely 8 hour bus ride ahead of me.

Thankfully I bought peanut butter and bread yesterday so I will pack some sandwiches to go.

I'm so excited to finally get to RIPPLE tomorrow and see the work that is done there.

I will only stay through the weekend then it will be off to Mzuzu.

Thanks for all of the comments! 

I like knowing you are enjoying hearing about my days.

I love that I can blog so I will always be able to look back on this trip and not forget the funny little details.

I may be absent for a while because there is very limited internet at Mwaya.

But I will update you when I can!

*350 kwacha = 1 usd

I'm pretty sure I got a shitty exchange rate at the airport though, and I refuse to remember how much I spent on everything today, so I will let you do the math.

I will leave you with a picture of the most delicious fish ever!