Marc's RIPPLE Africa Experience (February 2009)

"Rach and I look back on our time and, although we do remember the frustrations of African life, we have nothing but fond memories. Given our time again, we’d wouldn’t change a thing and will definitely be back to visit just as soon as we can. Anyone considering giving their time and skills to this wonderful community will never regret it. I feel refreshed in myself and am now ready to face the world again. Thank you, RIPPLE Africa."

My wife Rachael and I first met in Zimbabwe in 1999. I’m from the UK and was on my medical elective at the time, and Rach was coming from Australia and travelling in Zim, so ever since that time we have always had a special affection for Africa and African people. We’d talked about working somewhere in Africa and made plans to come before our big move to Australia the following year, so reading about Malawi and RIPPLE Africa in particular, we ticked all the boxes. RIPPLE AFRICA is a British based family-run charity, working in a safe, inexpensive, English speaking country, and we’d be living in an isolated rural community. I could work as a doctor and Rach would be able to teach and assist in other ways. After many chats with Liz, we booked in for six months from August 2008.

Before leaving, we spent a crazy few months in Brighton getting organised so that by the time we left we were absolutely exhausted and couldn’t wait just to get to Mwaya and settle in. We decided to fly in via Dar es Salaam so that we could visit Zanzibar on the way home, but this meant a mammoth four to five days travelling on planes, trains, taxis and buses of all sizes before we finally made it to Mwaya Beach. Nevertheless, it probably prepared us well for our experience. As soon as we got there we knew we’d arrived in paradise – the website photos, although beautiful, really don’t do it justice. We received a really warm welcome from the other volunteers and all the staff members and, after a weekend’s rest and Morton’s induction, we got stuck in.

It was probably easier for me just to start because, as a GP, I knew exactly where I should fit in, but it did take a little longer for Rach to truly find her niche. My working week consisted of getting up around 6.00-6.30am, having some breakfast, and then either walking or cycling the 6-7kms to Kachere Health Centre. The bikes were difficult to ride at best, but at least for the first few months when it was still dry, 20-25 minutes of cycling usually worked out better than the 50-60 minutes walking in the 35°C heat. Unsurprisingly, I lost some weight over the first couple of months, purely from all the exercise in the heat. It took me a little while getting to know all the staff at Kachere, but before long I was assisting with the Out-Patients Department and the Emergencies, even running it when the other staff were away. I tried hard not just to fill in and do the job of the Medical Assistant (Irene) or Nurse/Midwife (Janet), so I aimed to spend some time teaching them as much as I could – when time allowed. Most days we’d get started around 8.00-8.30am and, working together, Irene and I would see anywhere between 50 and 100 patients (our record being 114!) before lunchtime. A massive proportion of the patients were children under 5 years old, and pretty much everyone with a fever – in the absence of any investigation facilities – was treated for malaria. Other common problems were dysentery, chest infections, malnutrition, STI’s, and obviously AIDS and related illnesses. We did see some TB, but again with no investigations on site, it was difficult to get accurate diagnoses.

As you would expect, I had many frustrating times at the health centre. Firstly, I had to arrange my registration with the Malawi Medical Council – anyone who has encountered African administration will understand what that was like. The lack of equipment and sterility, essential drug shortages – we had no local anaesthetic for four of my six months’ stay – and no oxygen, inhalers or access to an ambulance for a lot of the time, made work challenging to say the least. We also had no running water, and I spent my entire time working out firstly why there was no water when previous healthcare volunteers had worked on this problem, and then secondly trying to work out how to fix the problem for the short and longer terms. I liaised closely with the District Health Officer, Dr Phiri, especially when we needed extra drug supplies, and worked with the staff to improve things wherever we could. The staff there are truly wonderful and made me feel so welcome all the way through my stay. Kachere was where I spent most of my days, and so I was obviously devastated when I had to leave.

On Wednesdays, I used to take the matolas or minibuses (always an experience in itself) and travel to Chintheche Rural Hospital. I’d spoken with Mr Hastings Sikoti, the Senior Clinical Officer, and arranged that I would come once a week to Chintheche to assist them with their ward round. The patients there could often be much sicker than at the health centre, but at least we had a microscope, oxygen and sometimes even a haematocrit for checking blood counts. Hastings was amazing. He effectively ran the hospital, and I can’t praise him enough, both for his clinical skills (despite only three years of training) and for his warm welcome that I received every week. We worked together going through the various wards and tried to teach each other as much as we could about the areas of medicine we knew best. I would recommend any future doctor volunteer giving some of your time to Chintheche Hospital as just going there is an experience in itself. Another massive plus was that it also allowed Rach and I to have some lunch at Mum’s Restaurant and do some shopping once a week, which could be a life-saver considering the lack of resources closer to Mwaya.

The rest of my time was spent between assisting Fletcher, the Health Surveillance Assistant, immunise the kids at the under 5s clinic, setting up an ‘underweight clinic’ for those falling behind, and helping the kids with various wounds they seemed to enjoy showing me. The staff members would also need some medical assistance for themselves or their family members from time to time and, although there really wasn’t much I could do at Mwaya Beach, I mostly just patched them up or referred them back to the health centre with a prescription. On occasion, however, we’d get an emergency brought to me at Mwaya Beach, and we’d have to rush them to hospital in the back of Benji, the charity vehicle.

Other than the medical stuff, I tried to assist with the environmental projects whenever I could as it was hard not to get upset with the situation that’s unfolding throughout Malawi. I worked to support some of the local lads who had set up an environmental club in the next village and had an arrangement with Chief Chalemba to clear some land for some reforestation work. I also took an interest in gardening – this being the first time I had ever had a chance to garden – and managed to get some decent cucumbers and watermelons among other things out of the volunteers’ garden.

In the end, it’s the staff and a few special volunteers that I will always remember the most fondly about my time in Malawi. Mwaya Beach itself is beautiful, and every day I felt lucky just to be there. The staff were all fantastic and became more like our family taking care of our every need so, obviously, there were a few tears at leaving time – Harry, Geddes and Martha in particular. Rach and I look back on our time and, although we do remember the frustrations of African life, we have nothing but fond memories. Given our time again, we’d wouldn’t change a thing and will definitely be back to visit just as soon as we can. Anyone considering giving their time and skills to this wonderful community will never regret it. I feel refreshed in myself and am now ready to face the world again. Thank you, RIPPLE Africa.

Marc (Volunteer Healthcare Assistant, August 2008 - February 2009)