The Dzalanyama debacle

We went to the birthplace of the Lilongwe river last Saturday, Dzalanyama Forest Preserve, recently featured in a New York Times article on the water crisis in Malawi. You can read that story here.

According to Google maps, it’s about 30 miles from Lilongwe and should take a little over an hour to reach. We took the road suggested by the app as the fastest (difference from the next fastest one: 9 minutes). A small digression about driving in Malawi: most roads don’t have names, and if they do, no one uses them. Google Maps is accurate about 90% of time in town; out of town, usually even better, and Airtel has service over what seems like 99%+ of the country, with 3G speeds for data. Still, the way you give directions is something like this: go to the Chipiku roundabout (not the new Chipiku, the old one, you know); take the third exit. Go past two turns to the right where you’ll see some goats on the side of the road; turn left. Go to the third blue gate on the left and we live across there, in the house with the purple tree in front of it. You get the picture.

We packed sandwiches, snacks, water, camera, sunscreen, and wanderlust, and were on the road by 8:30am. First clue that this trip wouldn’t go as we planned was how fast the tarmack ended and the road became dirt. Now, this isn’t by itself an unusual occurrence, since many roads in Lilongwe are dirt roads, including the one we live on; but usually the tarmack—or cement or whatever—lasts a little farther outside of the city than this one did.

But no matter; we’re such seasoned travelers now, having been here for over 2 months, that this did not deter us. We rumbled on the road, past the Kamuzu Dam, which provides water and power to Lilongwe (recently, not so much, as you can read about in the above article) and arrived at the border of the forest reserve (according to Google: about 5 miles from our destination of the Dzalanyama Forest Lodge). Here, a very nice man with a dazzling smile informed us that this was, indeed, the road to the lodge; however, “the bridge is broken” and therefore we had to turn around and seek another road. When asked for directions, he was very solicitous, pointing continuously to the left while saying “turn right here, then go straight, and turn right again,” so we decided to rely again on Google maps and found an alternative route.

This map doesn't show the thin white roads, or even the thick white roads. 

If you’ve ever used Google maps on non-highways, you know that there are yellow roads and white roads. We now found out that the white roads further divide into thick white roads and thin white roads, the latter, in Malawi at least, being essentially bike paths with grass worn on either side to barely the width of our Subaru Forester. Bikes and foot traffic are the dominant modes of transportation outside of the cities, and it was painfully clear that the last car had travelled here maybe at the end of the last rainy season, judging by how tall the grass had grown. We pressed on—we had a destination, after all, and damn it all to hell and back we were going to go hiking today—and then we came to a point where the rains or a creek had washed a part of the embankment away, and the “road” dove into a ditch. We would have to go down this ditch and back out of it if we wanted to proceed. We looked at each other; I said “no” but Micah said “Well, it looks like the road gets back to a more road-type thing once we get past this” and he was driving, so we went on. On this sandy bank with many trails from intrepid bicycles and no identifiable car tire tracks, we made our own. The Subaru bravely descended down the sand and then rumbled on up again, and took us safely if tensely to the other side.

After 3+ hours, we arrived. The setting is idyllic, full of bird song, the babble of the tiny Lilongwe river, fluttering of butterfly wings, and the hum of brachystegia leaves (acacia species). There is even the occasional whiff of eucalyptus, which were introduced here in the early 1900s. We hiked to our heart’s content and had our packed lunch by the water hole, where the kids dipped their toes (or, in the case of Stas, whole pant-encased legs). We saw lots of lizards and a stick insect. We had a blast. I was thinking we should come back here at some point again, maybe with a chauffeur who knows which paths to take.

The Google map app told us there was a slower road back, but this one was yellow all the way, so we were optimistic that we could make it back to Lilongwe and avoid our friend the thin white line. So we approached the return trip with some trepidation but overall optimism. We followed that yellow road over hills and through villages, where the children yell “AZUNGU!!!” and ring cowbells or bang tin pots whenever a white person appears, and then the road on the map disappeared. For a while we were off the map completely, our little blue arrow on the google map wandering aimlessly through a green nothingness; then the road reappeared as we drove through a village, glorious in its reassuring yellowness. I was driving and feeling optimistic; that is, until a deep, steep, completely impassable ditch appeared in the middle of my road, bisecting the path and making it impossible to drive any farther. So we turned around again.

By this point, our phone was running on fumes and we were also. The kids behaved relatively well, only earning two separate 10-minute long periods of enforced silence when the driving got really interesting. Micah found another road, which would lead us back to that original one (the one with the broken bridge), and theoretically safely back to Lilongwe. After driving back through the same village for the third time, to the enjoyment of all its inhabitants, we finally struck the right path and, after another 2+ hours, made it back to Lilongwe. Somewhere around hour 2, Agnieszka said “Wow, this is a great shortcut! Because we took it I’m not even tired!” At which point we just had to laugh.

As seen around Lilongwe...or Malawi...

I have a sad and homegrown philosophical post to write, but it’s still cooking in my brain, so I will stick to another topic. First I thought the title would be, “The things you can carry on your head;” then I thought, why neglect the bicycle? So “Things you can carry on your head and on your bike;” but that didn’t include some other fantastic sights, so I thought I’d entitle it “As seen around Lilongwe…” This will be a working post with additions as I get more documentation. Excuse the poor quality, these are mainly pictures taken while driving (oops) from my cheap-o replacement phone camera.

PART A: The many uses of a person's head.

You can carry a board...a REALLY BIG board...

Or a house...a small house...we see this guy with this same house on his head every week. Many stories have been developed as to why he walks around Lilongwe with a straw house on his head. The mystery continues. 

With the addition of your head, you can carry three bags easily...

... or a cooler....

or a gigantic basket. Or there bags, edition #2

PART B: The many uses of a bicycle

Wood? Bottles? Shoes? 

I think it's empty, but who knows....

A huge bag of sticks for firewood

Or...my all-time favorite picture: a dead goat and a dead chicken. 

PART C: Sundry traffic sights:

These three vehicles are all making a right at the same time, onto a one-lane road. That's like making a left in the US, i.e., you have to cross on-coming traffic. Somehow everyone survived, no honking was made, and the vehicles all squeezed into that one lane, one after another. 

Who needs power when you've got Batman shoes?

The kids go to an afternoon "camp" run out of the home of a woman we know through Beer'n'Babies (more on this in another post), every Wednesday afternoon, 1:30-5pm. They have sensory play, go outside and run around, and bake things at the end. This last part is a genius ploy to help keep kids coming, as the parents become incontrovertibly addicted to the yummy baked goods. Last week it was molasses cookies; this week, cinnamon buns. Yum!

Those cinnamon buns saved us from dying of hunger after we got stuck in Atlanta-worthy traffic on the way back from one of these camp sessions. It has rained twice in the last 3 days--an unheard of thing during the dry season here--and the resultant traffic was horrific. Not having moved more than 4 feet in 30 minutes, we decided instead on plan B: dinner at a local restaurant. Fueled by cinnamon buns, this plan seemed like a brilliant idea. That is until we had ordered, and the power went out.

Things to know about Lilongwe: cash is king. Credit cards work more than they used to, but mostly only at Chipiku, our fab grocery store

and at some restaurants. We went to Buchanan's, https://www.tripadvisor.co.uk/Restaurant_Review-g293811-d1214832-Reviews-Buchannan_s_Grill-Lilongwe_Central_Region.html

Advantages: chicken nuggets, wonderful gardens, frogs at night, and--you can pay with a credit card!
But when the power went out, I immediately thought: oh boy. Does the credit card machine work when the power is out? We had no cash, because we hadn't been planning on going to this impromptu dinner. Would we have to wash the dishes to make back all the imaginary Kwacha we had spent on this meal?

I asked the waiter, but he did the typical Malawian politeness thing of "nod and smile if you have no idea what someone says and say 'yes, Madam'" so I wasn't sure that he had understood me. Then the generator kicked in and the computer started to work before I could go further down the kwacha-less credit card anxiety hole.

The kids had to go to the bathroom. The generator powered the bar, the restaurant and the kitchen stove (thank goodness), but not the bathroom lights. It gets dark around 5:30 in Lilongwe, and there aren't many street lights, so it was hard to see anything in the bathroom. The glow from the hallway lit the area of interest just enough to enable successful completion of the task for two out of the three interested parties. Agnieszka freaked out and refused to go in; that's when Stas realized that his shoes still do light up, in spite of how beat up they are, and that they are in fact a perfect solution to a power-less restaurant bathroom. He proceeded to dance like a madman, stomping his feet, and light the way for his sister's toilet experience. We all laughed hysterically all the way back to the table. And then the power came back on, we had a wonderful dinner (my request for white wine interpreted as a glass of red notwithstanding), and drove back home in zero congestion.  No cinnamon buns survived the trip.

Being a kid in Malawi is almost as good as being a kid in Pittsburgh

Pure happiness

This post is for the grand- and great-grandparents. You're welcome :)

At Kumbali pretending to be horses

Agnieszka recently confessed that she thinks Malawi is the second best place she's ever been, behind only Pittsburgh. This after a week spent in Paris. Sigh.

Saltcrax...delicious!

Documenting. Serious business.

I'm beyond thankful that the kids have adjusted so quickly to being here. There are subtle differences. Their play now involves pretending to stop each other at police checkpoints, and Stas goes around singing a song that consists of repeating "Mefloquine, Mefloquine, Mefloquine" over and over again. School hasn't started yet, which will be a big adjustment, but overall it's taken a huge load off my anxious parental brain to see them thriving and just being kids here.

Micah also gets to play. Here you see him riding two scooters down the hallway of our house. What you don't see is Stas in running behind, and Agnieszka in front. A regular occurrence, right before bedtime, of course.  

More Kumbali

This is not how they sleep at night...

...this is how he sleeps in the afternoon....

...and in the morning....just not at night ....

Kids contemplating one of the world's best sunsets (according to TripAdvisor, so it must be true!)

Stas getting launched into happiness, and hopefully not into too much schistosomiasis

He is mad that is not Fanta Passion in the water bottle

Looking for monkeys at Cape Maclear

 Stas all alone getting ready to sail off into the sunset :)

Janek with our housekeeper, Aggie. 5 seconds before falling asleep, of course

In praise of skin

This is another work post; apologies if it's too graphic. I want to tell you about dressing change days, and about skin.

Mondays, Wednesdays and Fridays bring dressing changes in the burn unit. This means that every patient—as many as 42, plus the many others who come in from home just to get their dressings changed--line up at the end of the hallway and wait their turn, while 3-4 intrepid nurses unwind and wind miles of bandages, slather ointments, and squirt morphine into their mouths. Except when there is no morphine. Then it’s diclofenac, which is, I imagine, the equivalent of getting a swig of ibuprofen right before you get scalped alive.

Walk with me. From the outside, down a dark hallway filled with people, toward the light at the back and up the stairs, three flights. The staircase is open to the outside and on each flight there's a big window with a view of the city--today it's hazy and hot, so the buildings are distant under a screen of red dirt and smog--but it's not airy or breezy. The stairs are worn from countless people walking up and down it for years, and on the second flight a woman wearing yellow wellington boots is mopping, with a broom that's seen better days and concrete-colored water. On the third floor we briefly bump along behind two policemen, big guns swinging freely, talking exuberantly and walking oh-so-slooooooowly—and finally we arrive on the third floor, and walk down the hallway to 3B, the burn unit.

Before you open the door, take a little deeper of a breath, for you're about to experience that smell. On a good day you manage to take 3 steps inside before it hits--the odor of maize meal cooked into grits-like porridge, or a paste, or a hard cake (nsima); of bodies, urine and boiled cabbage, dirty wounds, feet, doughnuts, and fear--and then you see the mother carrying her five year old daughter wrapped up like a mummy with an IV tube sticking out of her neck--and you feel ashamed for even noticing the smell.

There are six rooms, 4 beds each, lining the hallway to your right.  Linking them is the open breezeway down which you’re walking, which opens onto a shared courtyard where people dry their laundry and family members cook their meals. On the other side of the rooms is another hallway, the khonde, or “outside,” which becomes another long communal room during the months when there are more patients in the unit than there are beds. During the cold season—June, July, August—the khonde is full.

Two boys, aged four and six, one with a bulky bandage around his leg and the other with a belly dressing, are playing with a glove balloon, and you toss it back and forth with them for a little while, their smiles lighting up the day. 

Are you procrastinating? We have to keep walking down the hallway, to the room at the end, where all those people are queued up, since that’s where all the action takes place. Each mother dons a protective plastic gown and gloves and takes the child—the median age here is 3—on her lap. The mothers hold the children down. The first trial begins, that of forcing the morphine into the children's mouths. Most take it willingly, especially ones who have been here a while, but sometimes they purse their lips, or cry, or swat with their arms. It doesn't matter if the morphine trickles inside or outside of their mouths--there is no refill and the dressing change happens with or without it. 

Next, the nurses soak the bandages in saline to help with removal. Since there are 42 patients and 3 nurses, waiting for a complete soak would take way too long. Some of the kids start screaming in the hallway; some when the mothers take them on their laps; some with the morphine; but all of them are screaming by this point. These kids are burned over 10-40% of their bodies, on average; over all possible body parts; in two main ways: they scald themselves or catch themselves on fire. It's the cold season in Malawi, no one has heat at home, and very few people have stoves; cooking happens over open fires, outdoors, and accidents happen frequently. Malawi is burnin', y'all: 

 

Skin gets so much criticism. We stare at our pimples as teenagers and wish them away; at our wrinkling faces as adults, and hate their testament of the passage of time. We scrutinize moles and massage cellulite; we want elasticity and spend millions on creams and lotions that promise to keep us looking young. Even as we enjoy skin's gift of touch, in embraces, caresses, and kisses, we resent and focus on its fragility, its ability to hurt, and too often, its color. We don't appreciate scars. Skin should be blemish-less and baby-soft. Not at all like the skin I see in front of me--discolored, twisted, partially healed, in some cases with the tell-tale cheesecloth appearance of a healed skin graft. This is beautiful skin because it works in its intended way: not as pretty packaging but as a barrier to infection and pain, as the selectively permeable wrapper that allows the rest of the body’s functions to proceed uninterrupted and unthreatened, with just enough openings to allow a regulated exchange with our environment.

It's the absence of skin that exposes its absolute necessity. This six year old girl being unwrapped now has full thickness burns (what we used to call third degree) over 55% of her body: anterior and posterior thorax, both legs, both arms, a bit of face and neck, buttocks. Her big, deep brown eyes look at me with tears trickling down her cheeks as her mother’s helper raises the IV bag above her head and arranges it so the tubing is not kinked. This is a bad burn: flame generally causes deeper burns than hot water, and in this case, it looks like her clothes were on for some time, and the contact did a lot of damage. Like countless others, she was playing with her friends and tripped into a fire, where her clothes caught the flame. She cries, but not much: a bad sign. Although we teach that full thickness burns are insensate, since by definition the heat has destroyed the skin's sensory apparatus, not everything burns to the same depth, and partial thickness areas surround most full thickness burns—and those do feel pain. Her name is Chisomo, meaning Grace. She will die in 3 days. 

I think about the ones we can’t save, back home, and here. I hold on to them for motivation to keep studying, keep waking up, keep leaving my family, and keep trying—and to honor their memory, although I see them usually only in a dehumanized form, although I know them usually only as bodies wrapped in dressings and not as children chasing goats, eating mangoes or diving into the lake. Knowing what makes a patient human makes me a better doctor but it also hurts more—and many times I don’t want to admit they are people because doing so makes me transiently incapable of returning to work. It’s like this in the States and it’s definitely like this here. The constant blur of activity insulates you from processing both the good and the bad, but both stay with you, and sometimes when you get a breather it all comes out, and it’s very hard to figure out what to do with all of it—so I try to just notice it and not cry, and carry on, because in the end, there are more of the ones who get to be human again than the ones who don’t, and so you keep going. As shown by the parents and patients in this burn unit, every day, with their smiles, their high fives, and their endurance, despair is a luxury. Ain’t nobody got time for that.