Why I love Malawi....

I have now been in Malawi for 4 months and time is flying by! There are still extreme highs and lows but in general things seem to be a little bit more stable! I am loving the laid back way of life and the sun. Because things here can vary from day to day I’ve found its really important to stay focused on the positives. There are many and I want to share with you all the things I am loving about living in Malawi!!

Nkhoma – My new home. Set on the side of a mountain with gorgeous views. This time of year has brought out lots of Jacaranda trees they have the most beautiful purple leafs. Its not rained in all the time i have been here so things are getting pretty dry. But its amazing what manages to still grow despite the lack of rain! The village is relatively large… there is a market, a shop, a petrol station, a post office and a church. I’m not quite sure of the population but the people are all friendly and I’m adjusting to living in a smaller community where everyone knows everything about everyone. I love that wherever you walk someone will greet you and ask you how you are.... a very far cry from my busy London commutes where eye contact is viewed as a crime!! 

The students – At first I struggled. I have this thing of wanting to be accepted straight away and find it hard to realize that things take time…. But now I feel I have built up a really nice relationship with the 3^rd year students I have been working with on the labour ward! I have seen them grow and take on board things that I have taught them. The approach to midwifery care is quite different here so I have been trying to teach them the importance of woman centred care and being kind to women. The students realize the importance of this too but aren’t used to seeing it in practice which is sad. They are also now a lot more likely to ask me for help if they don’t know something. There seems to be some kind of stigma attached to admitting to not knowing something. Which can be dangerous but getting them to realize that its ok to ask for help feels like a big achievement!! They will be finishing their training in December so now is a very busy time for us all!! We also have some new student midwives starting in a couple of weeks. These students will be training to become community midwife technicians. I’m really looking forward to working with them!!

The women – Malawian women are amazing. They are strong and independent. They have to battle with extreme gender streotypes from a young age. Its not uncommon to find women out working to support their families but receiving little recognition. I feel privileged because I get to work with these women during one of the most vulnerable moments of their life. They go through labour making very few complaints. They have no pain relief and they are not used to kindness. Most of the women I care for do not speak English but I still feel like I am able to communicate with them on another level just by smiling and holding their hand. I can feel how grateful they are for this. I have so much respect for them and they are what make my job worthwhile. When things get challenging focusing on trying to improve things for them gets me back to work the next day and makes me want to keep fighting.

Meeting new people -  During the last 4 months I have met so many new people. Some I have established good friendships with, others not so much… but from every new person I have met I have learned something! I already knew that you will never get along with everyone in life. I am trying to develop my ability to deal with challenging people and remain positive…. Its tough! People often have different views on doing things and I am learning to be adaptable. Some people in life will never change so there is no point stressing out trying to get them to! Instead I will focus on the many wonderful people that I have had the pleasure to meet and spend time with!! There are so many interesting people in the world and I love hearing peoples stories and learning about their experiences. We have just had our volunteer peer support. We spent 3 days at a lovely retreat in a forest. The purpose is to bring all health volunteers together to share experiences and offer moral support. It was great because I realized that many of the other volunteers face the same frustrations and challenges. So I am just as thankful to the people that challenge me as I am to those who support me because they force me to grow as a person and address things I would rather avoid.

Travelling – Malawi is a beautiful country and I love travelling around it!! I feel very lucky to have the opportunity to explore during my time off. Travelling also gives me the down time I need when work has been especially hectic!!! The lake is my favorite place, its huge and is more like an ocean then a lake except its not salty so swimming in it is magical!! Last weekend was lake of stars music festival which was held by the lake in Mangochi. It was a combination of good company, good music and amazing scenery… perfect!! I’ve also had the opportunity to do a couple of safaris which are so much fun. Being with animals in the wild is so beautiful. I hope to do a lot more travelling while I’m here!!

I am really glad that I am beginning to see Malawi as my home. I have more of an idea now about what I hope to achieve during my time here. Its easy to get carried away with what you think you should be achieving but I think it’s the small things that can have the biggest impact. So now when things get tough I will focus on the things that I love because these are the things that are important!

 

Learning curve...

Sorry I haven’t updated for a while. Quite honestly I haven’t really known what to write….

2 months in and I am on the biggest learning curve of my life. Take everything I thought I knew about the world and put it in a box and forget about it. Life here is that different I feel like I am starting from scratch. I am trying to learn a new language…. Its difficult but in order to be able to properly communicate what I want to say to women I feel it is essential. Its hard having to rely on someone to translate for you all of the time and I am never 100% sure that what I want to say is being delivered. There is such a difference here in the relationship between midwife and woman. Shouting at a client is shockingly acceptable (despite many protests on my part) The women here have no pain relief in labour and as part of the culture are expected to keep quiet and get on with it. You never hear a woman here moan or complain. This birth culture is alien to me and I am struggling to adjust. You begin to question all of your morals. How can I let this happen? But in reality the real question is how can I work here and develop a relationship that may have some influence to help them see that this behavior is not ok? As you can see the second question is far more complex then the first. This sums up everything I am trying to do. Everything is complex. You cannot just walk in and make changes. Its very easy to identify where the problems may lie. In fact midwives shouting at women is one of the smaller problems there are many more worrying things that I have been a witness too. Thinking like this alone has taken me a while. Before I would see it all as unacceptable and not stand for any of it. Now you really have to choose your battles and fight for the things that can make differences to life and death. I am struggling with it. I have realised things that seem simple to me are far more complex here. My whole career I have worked on the belief of woman centred care. There really is no such thing here. I am trying to fight bigger issues such as this while addressing the smaller ones such as not leaving babies to get cold after birth….

Since my last post I have finished my orientation and begun work as a clinical instructor.

I love teaching! I never realised it before but I really do! The students that I am working with at the moment are in the 3^rd year of their course and have had very little midwifery supervision in their clinical placements thus far. This is a challenge as they have been used to being left to get on with it…. So at the moment I am gently trying to earn their trust so that they can come to me and ask for help. I am also working with them quite closely to see what they know and where they might need some support. One of the areas quickly identified was with suturing so I was able to arrange a particle suturing session in the colleges very well equipped skills lab!!

Along with trying to change the way I think and approach everything in life… deep! I have also been taking some time out at the weekends to travel! This is the best part so far about being in Malawi! It is such a beautiful country and I would like to see as much of it as possible while I am here. The lake is glorious, hot weather and crystal clear waters. It is a very welcome escape!! I have been twice in the last few weeks and enjoyed every second! Also it is currently winter here and Nkhoma is set upon the side of a very large hill (mountain) so at night it get extremely cold! I never really paid much attention when I was told I would need a jumper in Africa and only brought one with me…. So I have had to go shopping for some warm winter clothes. Apparently I shouldn’t moan as in the hot season it is unbearably hot… but those of you that know me will know that I do not suffer the cold very well at all!!

We have also had some new additions to our VSO Nkhoma family! They arrived around the same time I did (good omen) and have been being very well looked after by their mother and are now big enough to be out and about!!! They may look cute but don’t be fooled they are vicious.. in a cute way!! We are currently trying to get them not to be afraid of humans.

To top all of this off last week I discovered that despite taking anti malariels, sleeping under a mosquito net and going through daily chokings after spraying myself in deet I had caught malaria! Typical!!! It totally wiped me out but thankfully because I had been taking prophylaxis the symptoms were milder then they would have otherwise been… I just had zero energy and felt dizzy whenever I tried to do anything… Looking back I think I had the malaria for a while before I got tested as an annoying health care professional I self diagnosed and commenced on iron suppliments as I was convinced this was the problem… Oppps but now I am recovering well and have a very healthy Haemoglobin so win win!!

There really is never a dull moment here!! 

Reality check

Last week I was very busy on the delivery suite and at the weekend I travelled to Liwonde safari park which was a very welcome break!

The labour ward is very different to what we have in the UK. The ward is divided up into 6 cubicles that are large enough for a small bed and a little walking space either side! There is no such thing as privacy on the ward, which I found quite shocking. You are able to stand in one bay and look over to see what is happening in the others… However I soon discovered that quite often there are only two midwives on duty and the ward could be full and therefore they need to be able to easily see what is happening with everyone. I found quite quickly that I had to stop trying to compare things to what I am used to and just go with what they have. The midwives here work very hard in a very poor resourced area and they really do try their best. I think as an outsider its easy to come in and see where things can be improved but its important to first understand why things are being done the way they are. I had a very interesting week that involved lots of births including two breeches and twins! 

They do not have an obstetrician where I am working so the midwives do everything… its great!! I managed to do lots of promoting of delayed cord clamping and skin to skin which made me feel like I was achieving something even if it was just with my women… for now.

Friday afternoon one of my worst fears I had coming here came true. Sadly we lost a mum. I knew it would happen at some point and with such a high maternal death rate it was inevitable. However that does not make you any more prepared. It was horrible. We did everything we could for her but it wasn’t enough. She left behind a 10 day old baby who will now be cared for by her husband and extended family.

It really reiterated to me the highs and lows you experience on a maternity unit. I was so happy that I’d had very positive outcomes with all my births. I was actually having the best week ever. But in an instance that all changed. The most frustrating thing is if the right resources had been available the outcome could have been very different. But that’s a very big if. It brought me back down to earth. I am in Africa and the situation here is not good. The focus is on maternal and infant mortality for a reason. Volunteers are really needed here. I just hope I can make a difference! 

I was very glad to get away at the weekend to somewhere so tranquil. It gave me some much needed time out to reflect. We saw lots of hippos, which are supposed to be one of the most dangerous animals in Africa… but I think they are quite cute! We also saw lots of elephants, baboons, waterbuck and wart hogs or as our guide referred to them, Pumbas! On our way home we stopped off at a market where people selling their fresh produce surrounded our van. It was great I did all my shopping through the minibus window! I arrived home Sunday evening recharged and ready to face the week ahead!!

 

A whole new world

Soooo much has happened since my last post and I am only two weeks in…. I have been all over the place and I am still sticking to the plan of just taking it as it comes!! The highs and lows really do go from one extreme to the other… I wasn’t really prepared for that. In all of my preparation to come away I knew how important it would be to make connections with the volunteers already in country… now I am here I realize not only is it important it is a lifeline! I really don’t know what I would do without them! Arriving not only into a new country but a whole new culture alone is SCARY!!! Nothing-here works as it does in the UK people’s attitudes to everything are so different. I am so used to having an order to doing things that allow me to be most efficient. Those of you that know me know I am not always the most organized person…. Compared to here I’m a control freak!!! Its fine and I can go with it until I need to try and get something done, then it’s frustrating. Its funny though because everything works out just fine… people just don’t seem to get too stressed maybe I will learn a thing or two!!

One top tip that I have learned the hard way, do not bring travellers cheques to Malawi. No where will cash them!! I eventually managed to talk to someone (after being sent from piller to post) that allowed me to pay them into my account… but it will take 3 weeks to clear..grr. However my UK bank card works perfectly well here so I actually would have been better to leave the money where it was and withdraw it, rather then making a last minute dash to the bureau de change at the airport and being stuck for cash week one… That was probably my moment of feeling most vulnerable. New country, no access to money…shit! But an angel in the shape of another volunteer came to my rescue… like I said a lifeline!! Lesson – never travel without your debit card and never rely on traveller’s cheque!!

My meeting with the Malawi Nurses and Midwives council was very interesting… the lady I spoke with didn’t really understand A. that I am “just” a midwife and B. That I could be a qualified midwife without ever doing a ventouse….. Midwives here are expected to carry out ventouse births, breech births (yay) and there is no such thing as a forceps birth!! After a very interesting conversation I managed to convince her that I am indeed a qualified midwife!! She then informed me that I would be able to complete my orientation at Nkhoma district hospital. I will spend 4 weeks working on the maternity unit to obtain my MNMC registration.

My new home

Arriving at my new home in Nkhoma was definitely a high. It was above any expectation that I could have had. It’s a beautiful old colonial house set up on a hill with beautiful views. I am sharing with two other VSO volunteers who have been amazing in helping me to settle in. We have a massive garden with an impressive vegetable patch that some previous volunteers put a lot of hard work into, very grateful to them!! We are lucky as we can get all of our fruit and vegetables from the garden, which makes a huge difference when living on a volunteers allowance.

The college is also very picturesque! There are 3 classrooms, a relatively well-stocked library and an amazing skills lab that I cannot wait to get my hands on. Very exciting!  

The college

This week I spent some time getting to grips with the curriculum at the college. We currently have 75 first year students and 49 third years. We don’t have any second years due to financial problems. The students here train in both nursing and midwifery. The students that I will be teaching train for 3 years to become Nurse midwife technicians. They do two modules of midwifery theory and practice in their third year. I have learned that these students obtain a certificate upon passing that is only recognized within Malawi and which doesn’t recognize the students as “professionals”. This is because Malawi as with a lot of African countries face the problem of training nurses and midwives that will go on to leave the country and work abroad. The nurse midwife technicians are then deployed to areas where it is felt they are needed. 

A classroom

A key focus here at the moment is on maternal and child health. The maternal mortality rate is still very high at 675 per 100,000 births. There is currently a debate around converting the qualification so that the students can be recognized as registered nurses/midwives, which is a Bsc qualification. It is all very difficult to get to grips with. It seems bizarre to me that the students train for so little time in midwifery when it is one of the areas where the skills are most needed. I am definitely going to have my work cut out!

The library

 On Wednesday we travelled back to Lilongwe for a conference aimed at “valuing nurses and midwives and the role of international and local volunteers in improving health service delivery in Malawi” It was a very positive conference that brought together leading organisations and volunteers to discuss all manner of issues surrounding Maternal and child health and what is being done in order to combat such issues. It was really good to see that the problems that are being faced in Malawi are being recognized and that people are working very hard together in order to try and bring about positive changes.

The conference

It was at this conference that I got to meet the other VSO health volunteers from across the country. All of who were very welcoming. I was particularly excited the meet the only other midwife volunteer currently in country with VSO we had a lot to discuss!! Unfortunately though my time at the conference was cut short as the next day I was taken sick with a very horrible bug that resulted in me being admitted to the hospital and missing the second day of the conference… I had rather hoped my first hospital experience would be as a health care provider rather then a patient but hey! It was very interesting to observe the different ways things are done. I’m sure the private clinic that I was in is not much of a comparison to where I will be working. But it was a gentle introduction to how basic health care facilities here are. Now I am well on the mend and preparing to start work at Nkhoma hospital tomorrow. Where I am sure my eyes will be opened even wider!!