Day 3, The chicken stew had feet in it

I woke up at 6:45 and stared out through the blue gauze of the mosquito net. The night was chilly, and I slept well.

We met Dr. Mlotha, head of the dental department, at 8:45 to go over our plans for our time in Malawi. Afterwards, she gave us a thorough tour of the grounds and facilities. There are two separate facilities in the hospital, one for those who can pay and one for those who can’t.

The payers (as she referred to them) had the option of a private room, meals, bedding, and other sundries. For the non-payers, they were four to a room. Families camped out on the grounds during the day, and they brought their patients food, clean clothes, etc. As we moved through the open air halls, we were constantly avoiding family traffic. Pots precariously balanced on heads, blankets and rugs were tucked under arms, babies strapped in slings across backs.

We went into the dental clinics after the tour. I went to the diagnosis clinic (which was actually the extraction clinic). I followed around a third-year dental therapist named Innocent. The extraction kit in the diagnosis clinic includes only a syringe and a pair of forceps (pliers for the non-dentist readers). A new staff dentist confided to me that if they couldn’t extract the tooth with that equipment, they then resorted to modified elevators to pick out root pieces. She considered the therapists’ abilities with elevators near-miraculous.

Our patient came in and described his condition. From the patient, Innocent took the patient’s “Health Passport.” This is a government-issued booklet (passport-sized) that acts as a mobile medical record. The provider documents the exam findings, treatments, and prescriptions in the Passport, which the patient carries with him when he needs treatment.

After the usual health histories, etc., Innocent got to work. He immediately performed the necessary anesthetic injections for the extraction of the upper right second molar. After a few minutes, he grasped the crown of the tooth with the forceps and began firmly rocking it back and forth. It didn’t budge.

Standing now, he struck a power-pose, legs wide-spread and slightly crouched. The muscles of his forearms were perfectly defined as he exerted his full strength on the tooth. A crack sounded from the patient’s mouth as Innocent sighed and showed me the forceps’ cargo. He had ripped the top half of the crown off, leaving the gingival crown and all three roots still in the patient’s upper jaw. He requested an elevator, and we waited patiently. When it arrived, I watched him maneuver the tip around the tooth until all three roots plopped wetly onto the pad of gauze.

Lunch for staff is served in a little building adjacent to UNC’s infectious disease folks. Three women operate simultaneous businesses in a 300 square foot room. For 150 kwacha (roughly $1), an enormous plate of rice, stewed vegetables, greens, and beans is yours. Two of the ladies operate nearly identical menus. For another 100 kwacha, you can throw in beef, offal, or chicken stew. Another woman sells cold sodas in vintage-style glass bottles for 50 more. If you go all out, lunch runs about $2. After a thorough perusal of the options, I settled on a plate of white rice and a coke. I’m going to try to buy some groceries to handle my own lunches from here.

We headed into town to get our endorsements from the Medical Council of Malawi. The streets of the city were thick with pedestrians and minibuses. Furniture and coffins appeared to be hot sellers in the numerous stalls lining the streets. $100 each in traveler’s checks gave us the credentials we needed to be able to legally practice in Malawi.

We got back to the guest house exhausted, and we rested until one of our preceptors offered us a ride to the American-style grocery store, the ShopRite. Needless to say, pickings were slim. Like Tolkien’s hobbits, I’ll tighten my belt and think about the good food at home.

Dinner, however, proved delicious. Ms. Joyce roasted a chicken, made a spicy vegetable soup, and cooked some rice. After a few battles of Charles’ card game “Tonk” (please excuse my spelling), I retired to type up today’s blog and get back on schedule.