Day 5, A day of firsts

We woke up early and headed 60 km south of Lilongwe to the Nkhoma Mission Hospital to run a free dental clinic. The road south was very different from the road we’d taken the preceding day. For the most part, the same crew as the preceding day piled into the minibus and sputtered along through the surreal landscape.

The road wound through several small villages, and in these locations the minibus had to contend with lots of pedestrian, goat, chicken, dog, and ox-cart traffic. We crept through dirt road detours and avoided bicyclists carrying impossible loads.

The landscape is remarkable for its general flatness. Subtly rolling hills are the norm, but they only allow you to have a slightly improved view and don’t give a sense of going up and down hills. Jutting up from these plains are enormous mountains of granite, sticking out like gorgeous sore thumbs. These became more common as we headed south, and eventually became continuous enough to be called a “range.”

Once in the mountains proper, we took the winding road to Nkhoma Mission Hospital. We were introduced to the patients as having “flown in on a big plane across a very big lake,” and they applauded us as we said our names. Like yesterday, we had multiple stations running simultaneously. One group diagnosed disease and referred to the three other groups for treatment: scaling, non-traumatic restoration, and extraction. Each of the UNC folks rotated through these departments. The group wasted no time in jumping into action, since they were lining up immediately, and as word spread to surrounding areas, the lines got longer still.

Many patients hadn’t heard English before. The area was decidedly rural. Women unabashedly breastfed their babies as they listened to the oral hygiene instruction that was given before the clinic opened. Older children played with bottle caps on the benches, or climbed over one another in the dust.

I found myself in the extraction room first. The doctor I was working with anesthetized the first patient and sent him back into the hall while we waited for it to take effect. I watched his technique as he explained his methods. When the next patient came in and sat down, he prepared the syringe and handed it to me. I smiled uncomfortably and said “I’ve never done this.” He responded with “Well, this will be the first time, then.” With his guidance, I successfully anesthetized the poor guy. Within the first half hour, I’d given two injections and extracted six teeth from children and adults. First injections, first extractions.

I’ll briefly mention the scaling again. Today was much worse than yesterday. In my scaling rotation, I worked on a single patient the entire time. Each tooth was coated in at least one solid millimeter of rock-hard calcified plaque. Working on a patient like that, with the wrong tools and an ergonomically untenable chair-operator arrangement, was a challenge for my back and my patience. We’ve got tomorrow off, so hopefully sleeping late will help.

We came home to a Joyce-prepared dinner of chambo (a tilapia-like fish from the area), rice, and vegetables. Our housemates, however, had decided that tonight was the night for a chicken barbeque. As we exited the bus, we saw four live chickens sitting with their legs bound on the front lawn.

At home, I get pre-butchered chicken from anonymous chicken factories. In Malawi, you do the dirty work yourself.

I decided that tonight was a good time to determine how comfortable I am with my omnivore status. I thought that if I was willing to eat chicken, I should also be comfortable slaughtering chicken. When it came time, I volunteered to slaughter one of the birds.

I’ll spare the details, but it’s not a particularly horrifying experience. In order to spare the chicken undue suffering, I decapitated it quickly. As a side effect of not letting it bleed slowly to death, my shoes and scrubs suffered some collateral damage (take a close look at the picture). We gave the innards and feet to Joyce. We didn’t ask what she used them for.

The chicken, which was as free-range as you can get, was grilled over illegally-made and illegally-purchased charcoal sold by men carrying enormous loads of it on their bikes. Real free-range chicken is tasty, but tough and chewy. A long night of card games followed, and when my housemates decided to go clubbing with a preceptor or two, I decided to call it a night. Who knows what’ll be here tomorrow? I have no agenda.