Two Clinics 2/18-22

Two more clinical days
Kawale Clinic
Kawale Health Center is in the heart of Lilongwe but still is accessed by a dirt road. When I arrived there the students were there but faculty was with the other half of the group on outreach. There were many women and children in the waiting room for immunizations and a student was already giving a health talk. When she finished she came out and organized the rest of the students as she had been appointed the student leader. Since this day only 15/30 students were there they were all assigned to do immunizations but she broke them up into teams. The guys were weighing children – see the photos. The rest of the students were oriented to immunizations by the health assistant who actually did a very good job of talking about the immunizations, the importance of cold chain, and the differences between the syringes. The students then began doing well baby checks – which depending on the student were very thorough or consisted only of putting the weight on the graph in the child’s health passport. Seven to eight students were at the immunization table and it was chaotic. They used the same dropper for all the polio vaccine and I am sure they must have contaminated even though I didn’t see anyone do it. The Bcg comes in a glass vial, the health assistant rubbed the neck on a corner of the table and then broke it open with her bare hands. It was a multiple dose vial that sat open on the table throughout the clinic. The DPT and measles immunizations were multiple dose vials but with rubber stoppers so they at least stayed clean. As if 50 or so mothers and children were not enough, at 9AM a long line of women who were at the antenatal clinic added to the chaos by making a line from the hallway. How anyone could keep track of who was being seen I will never know. Most of the babies looked healthy and I saw some really great mother child interactions. A couple of times I saw really young women who didn’t seem to know what to do with the baby – one of the health assistants said that usually meant it was a young sister who was sent to clinic with the baby by the parent.
Kawale clinic has a sink with a big sign in Chichewa that says “Wash your hands”. The sink is covered with dust, and the facet is covered with an old glove. There is no water and no one was washing between kids.
Likuni
Likuni is a village about 20 Km (15 miles) outside of Lilongwe. To get there we drove on tarmac for a while then entered a market town where the road became rutted dirt. Then we drove through corn fields so it rather looked like Iowa. The maize goes on and on and right now it is so high you can’t see over the tops so it’s just a wall of corn. Under the corn they have planted beans and pumpkins, and next to it sweet potatoes. After a long, noisy ride (the students sing, shout, and are generally noisier than a group of middle school kids) we arrived a brick building in the middle of a maize field. As we drove up a large group of preschoolers and perhaps kindergarteners came out – the building is used as a preschool except when there is a clinic which is about once a month. Next door there is a nice house where the pre-school teacher who apparently used to be a nurse lives. She let us use her very nice and absolutely clean outhouse and provided us with water for washing. We waited a while for the women to make their way to the clinic and the faculty (2) this time put on their chitenges. They use them like aprons and if I had known I would have brought one because we have to sit on the floor to examine the children. I pleaded old age and sat on the steps – I can sit on the floor but getting up is not a pretty sight!
This time we had water for washing because at the last minute the faculty (probably because they saw me on the bus) sent the students back for the buckets. As usual the clinic began with a health talk – this time appropriately on burn prevention. Everyone here cooks with wood fires and I saw children who had been burned. Then there was the singing of the health songs. (I have a great video which I will try to post on U tube later.) Some of the mothers in this village are Very very young – several looked no more than 14. They are poorly educated or not educated at all. (I happened to see the literacy rates from the most recent census in Malawi (2010) central region where we are has the lowest rates overall and the female literacy rate is somewhere around 60%). They will have terribly hard lives with unrelenting labor, will likely have several partners before they are 30, and will suffer hunger and malnutrition, multiple bouts of malaria, and these days likely HIV/AIDS. HIV is more likely because of some cultural practices in the countryside that I will describe later in a blog focusing on them on and what is being done to change them. The children while much smaller and more likely to fall on the underweight side of graph than the ones I saw in Lilongwe seemed healthy although the parents often complained that the child had every symptom on the list in hopes of scoring some meds. Students who worked with me washed their hands and few others did. How do we make this simple change – I asked Dave the Pediatrician from Yale and he said there is little hand washing and few facilities to do so at Queen Elizabeth Hospital – the biggest and most advanced in the country. Besides he says there is no soap but even friction without soap is better than nothing and a little bleach in the water even better. What is needed is a culture of hand washing and I am not sure how we get there.
Most of the children I saw were pretty healthy although I saw two really nasty cases of impetigo one all over the face and scalp. I also saw a set of twins one of whom was remarkably smaller than the other. I am not sure why that would be because Peds is not my area but I am getting better at it. I also talked to a mom who probably had a corneal abrasion from getting hit in the eye with a piece of firewood and another one with a nasty laceration that probably should have been sutured but that was never going to happen. Of course when I say I talked to parents I did so only through an interpreter because few speak English in the villages and although my Chichewa is improving I can in no way speak it. I must say people are usually impressed by my efforts since apparently few mzungu even try and I can occasionally make a whole sentence. I hope to visit the hospital next week but will not be able to do pictures there I don’t think. I am missing everyone and looking forward to a visit with Mary Rathert in Zambia and a trip to Victoria Falls in two weeks.