Volunteers’ Stories: Jo
“… back at the beach, the race is on to shower and do anything at all that requires light before the darkness swallows us up. The kitchen is a bustle of activity with all the volunteers asking one another about their days. The teachers of the group are pouring over their preparations for the next day, others are chilling. As the darkness falls, the fishermen take to the waters and the drums begin. Every single beat, every single moment is a special one.”
A day in the life…
It’s a glorious morning at Mwaya and the sun is rising, brightening the morning, as I make my way down to the lake for a quick swim before starting my day’s work. My morning swim is my moment of silence; in a short time, the lake will be busy with people washing, fishermen, and kids playing. By the time I have showered and dressed and made my way to the kitchen area, the RIPPLE camp is a hive of activity. The workmen are cheerfully loading planks onto Eddie, one of the charity’s vehicles, Geddess and Martha are singing while they gather together the volunteers’ washing, and Morton is doing something with a calculator in the office. Endless smiles and loud greetings from all, “Myoka uli!”, and I marvel at Rhiannon, the volunteer teacher, who is cycling towards the track with toast in her mouth, a bag full of books wobbling on her back and apparently speaking fluent Chitonga.
Checking that my bag is packed with the dwindling supply of drugs and dressings that my friend Vicki and I brought with us to Mwaya, I hurry off up the sandy path towards the road. I say hurry, but a more accurate description would be moments of acceleration in between stopping to greet and be greeted. The first house I come to belongs to a gentleman who was taken to Kachere Health Centre by Nav, who is also volunteering with RIPPLE Africa. The elderly man is usually very well but had rapidly become septic the previous week. Following a few days of treatment, he is home again now, and I pop in to see how he is doing. He is not eating and drinking, and he is very tired. I explain to the family that he must rehydrate, giving them some oral rehydration therapy, and suggest that if he does not improve, or cannot tolerate the fluid, he should come to Chintheche Hospital for inpatient treatment.
Jo, a volunteer nurse, from Northampton
Jo treating Irenie, a three-year old girl who suffered serious burns after falling into a three-stone fire
I press on, trying to keep up the greetings as I go, waving to the guys at the library and the kids at the school who are shouting, “Give me money!”. I’m almost at the road but have to turn off the path at the water pump to visit Irenie, the three year old girl who first came to the beach two months ago after having a seizure while suffering with malaria and falling into the three-stone fire. Her burns were extensive, she had full thickness burns to her ear and an area on her back, and partial thickness burns to her arm, torso and face. Immediate rehydration, daily dressings, prophylactic antibiotics, and nutritional support had had an amazing effect and, as I round the corner, her family call her to see me. A grinning girlie, naked but for the dressings that still adorn her head, arm and body, bounds up to me throwing her arms around my leg and jumping up and down. She also has five plastic necklaces, twelve bangles and a variety of balls, yoyos and stickers scattered about her – my briberies to her! Shameless healthcare this may be, but this little girl has been compliant with her treatment every single day since her accident, and the poor baby has suffered a lot of pain in this time. Today I remove her dressings while Irenie’s brother collects the clean water for me to use. Her skin is intact, and her scars amazingly minimal. I am constantly amazed by the endurance of the human body here, where no ITU facilities, hardly any drugs, and meagre nutrition exist. Irenie has a wonderful family, and her dad tells me that he makes sure all his children eat beans and relish most days. The minerals and vitamins that her parents give her have helped Irenie to recovery. Irenie’s great grandmother rests against the house, and her nephew translates that she has had pains in her chest. It turns out that this 96 year old has been getting a central chest pain regularly, and the pain occurs every morning after she has walked two uphill miles to the farmland and dug, sliced and cut the cassava for a few hours in the sun. Her pulse and blood pressure are normal, she has no signs of poor circulation, and her chest sounds clear. I tell the old lady to take it easy, and the family fall about laughing. The great grandmother jumps up from her position on the ground, and swings a child onto her back, waving her goodbyes as she wanders towards the water pump carrying a few basins.
Finally at the road, I find a shady position to watch and wait for a vehicle. The police are doing a fine job of protecting the roadblock while pointing out the mzungu (white person) to one another. Everyone around here is so used to the RIPPLE volunteers that you rarely get called a mzungu, but the police rotate to the Matete roadblock and sometimes a newbie is quite astonished to see a big, funny coloured person stroll up the path. Presently a matola arrives, and I jump aboard the pickup truck, squeezed next to a man carrying a fish, and a basket that I suspect is full of more fish.
We pass through Kande and I spot a few people I know from the Mwaya Home Care Team with whom Vicki and I have worked a little and carried out some teaching with at Mwaya Beach. They call out their morning’s greetings and I reply, everyone in the matola laughs, this makes me laugh, but I am trying not to breathe. I might talk a good talk about the nutritional benefits of fish, but, personally, you can keep it!
Healthcare training at Kachere
We arrive in Chintheche at 8:45, and I hurry up the track to the hospital trying my chitenje around my legs as I go. The waiting room outside the Wound Care room is full, hundreds of faces patiently waiting, and a million different chitenjes. The room that we use for the Wound Care clinic is basic. It has an old metal examination couch but no cover, a sink but no soap, and a table covered in stuff that is usually used for the dressings. Emily and Clare were volunteer nurses here when Vicki and I arrived, and they had been operating the clinic three times a week between them. We continued the service, and it became a favourite part of our work at the hospital. I have always liked wound care, it is so satisfying! Another benefit is that little communication is really needed; the patients tend to simply offer a leg ulcer, and nod at the sign language advice. Today was no exception, and my first patient silently entered, dropped his trousers and bent over to reveal a large peritoneal cavity. This was cleaned, packed and covered, “Mawa”, I suggested, meaning tomorrow, the gentleman nodded and thanked me.
The next lady in had been chopping wood, and her finger, and had an improvised dressing very well adhered to the tissue. She sat and soaked her finger to try and remove the stuff without too much trauma and watched the next 10 patients who, bit by bit, were able to translate her story to me while the fingerless lady peered at their wounds. My Westernised values will not desert me, and I kept asking patients if they minded the lady soaking her finger being in the room while I tended to their ulcers, gashes, rashes, and grazes. No one minded, and they were all amused by the question. Eventually, no more distractions are outside the door, and I was forced to admit that the muddy material was not going to come away without some pain.
After the clinic, I head over to the inpatient wards to find Nav. He is reviewing some malnourished children and seems pleased with their progress. The tiny old man’s faces of the marasmus child atop the frail body still shocks me. Coming to Malawi, I was prepared to see the disastrous effect of disease and to feel the unfairness of a world where a simple treatment that we take for granted in the West is not available. However, I was neither prepared nor accepting of the sight of a starving child. Some of the children that we had seen were starving because of physical problems, and sometimes it was through lack of food. Many children suffer with kwashiorkor, the condition that causes a swollen abdomen and swollen limbs when the diet consists almost entirely of carbohydrate. The developmental problems associated with this are sad. The pure starvation that is seen in the child with marasmus causes apathy, failure to thrive, and death.
Plans are underway to plant and farm community gardens that will provide food for emergency nutritional support. Nav has been working on a protocol for this treatment, and it is hoped that this project will be self-sufficient in the future, ensuring that the community can access help whenever a child needs additional feeding. This protocol will help guide the HSAs who will be responsible for identifying the children that need the feed, and advise them when to refer the child for inpatient treatment. Nav is just finishing examining a child that he brought over to Chintheche from Kachere for inpatient feeding; the child looks much brighter today.
Back at Mwaya Beach, Vicki is arriving home from her morning at the Under Five’s Clinic. These community based clinics monitor the weight of the children under five years old in the community. This is also the venue for vaccinations and review of any children that have been unwell. Vicki is in the kitchen talking to Alison (a volunteer nurse) about Gift, a child who they are bringing to Chintheche tomorrow for feeding.
Vicki, a volunteer nurse from Northampton, dressing a young boy’s wound
Nav, a volunteer doctor, teaching adult learners about the heart
One of the malnourished children at the Under Fives Clinic
This afternoon, I have been asked to help teach a class of adult learners; the subject is the heart, and I’m happy with this, but the location is Mazembe 2, and I’m less happy as it’s an uphill ride, and it’s a little warm … and the language is Chitonga.
The translator did not arrive; however, one of the learners, Charles, speaks excellent English and he is able to translate. The adults in the primary school classroom are here for the simple reason that they want to learn. They will not get a certificate or a job from this lesson, but they walk a long way every week to learn. With the use of the chalkboard, Nav and I took it in turns to talk and demonstrate the conduction system and the chambers of the heart. The subject matter was quite alien to some in the classroom; however, we persevered. Charles was doing a fantastic job of translating and, at one perfect moment, he understood very clearly what we were teaching. He came to the front of the class and used the board to reiterate the lesson. I was immensely proud.
Finally, back at the beach, the race is on to shower and do anything at all that requires light before the darkness swallows us up. The kitchen is a bustle of activity with all the volunteers asking one another about their days. The teachers of the group are pouring over their preparations for the next day, others are chilling. As the darkness falls, the fishermen take to the waters and the drums begin. Every single beat, every single moment is a special one.
Jo (Volunteer Nurse, August 2010 to December 2010)