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.

Day 2, The trouble with life is there’s no danger music.

Tuesday found us fairly early. Our flight to Lilongwe left at 11:20 AM, so we had agreed to meet the minibus driver at 8:45. Requested wake-up calls never came, so it was a bit of a scramble to meet the driver on time.

On the way to the airport, we got to see a bit of Johannesburg in the daytime. It’s a little bit like Atlanta, but there’s a vaguely European vibe around the entire place. I took a picture of this excellent billboard:

As we boarded the plane, there was a general sense of eagerness to get out and see the “real Africa.” The plane ride was uneventful, and we soon got our wish. Things were pretty different when the plane set down in Lilongwe. A dog was visible trotting down one of the runways.

Our extremely gracious hosts from Kamuzu Central Hospital picked us up at the airport in an older minibus. We sped away along the Malawian countryside, dotted periodically with the smoke plumes of trash fires, people resting along the side of the road, and women carrying heavy loads balanced perfectly atop their heads.

Traffic here takes three forms: the dangerously overcrowded minibus, or (despite the wide footprint of the capital city) walking and biking. We’ve been told that no matter where one goes in the distant countryside, there will be people walking roadside.

The accommodations are comfortable and dorm-like. Ms. Joyce runs the UNC Guest House, and she’ll be acting as a surrogate mother while we’re here. A few other UNC folks (a couple of medical students, an IT guy, and a lab guy) are sharing the building with us, and they’ve been very welcoming. The people have been uniformly friendly. After dinner at an Italian restaurant, we headed home in the streetlight-free darkness.

I’m hoping tomorrow will be sunnier and warmer – supposedly there are house geckos that live on the building. Seeing them would be a real treat. We’ll get a tour of the facilities and register with the Medical Council of Malawi, and then on Thursday we set off to the Home of Hope Orphanage.

Day 1, Raleigh to Dakar to Johannesburg

South African Airlines has a wonderful feature on its intercontinental planes. The monitor set into the back of each headrest has two unusual options. One is a view from a camera positioned atop the plane’s tailfin, so that if you’re cursed with being in the center seat you can still appreciate the view outside the plane. The other, better option is the plane’s realtime position on a world map.

As we approached Africa, the names read out like a fantasy novel. Dakar. Nouakchott. Banjul. There is a sense of foreignness that immediately struck me as I scanned the map. As the tiny plane icon moved across the topography of the floor of the Atlantic, these locales began approaching from the right side of the screen. There was a surprisingly affecting anticipation as the icon skipped over the Cape Verde islands, or once North America dropped off the left side of the map completely.

We stopped for refueling in Dakar, Senegal. After eight or so hours on the plane, I was eager to stretch my legs, but as it was a quick stopover, we weren’t allowed to leave the plane. We took off again before the sun was fully up, and clouds and rain prevented me from gaining any sense of the surrounding landscape. We settled in for another eight hours from Dakar to Johannesburg.

We landed and hustled off through more administrative hurdles. Immigration was a breeze, and I delighted in the inky tattoo their stamp left in my passport. We collected our absurd amount of baggage, secured a minibus, and headed to the hotel.

Entering an unknown city at night is a strange experience. As the minibus moved through its iterations of missed turns and re-tracing our steps, I stared out at the silhouettes of the elements of the skyline. I think the city is abstracted by the lack of light. You catch the city getting ready for bed, as it puts on its pajamas and settles down. All the businesses close early here, and so even by 7:00 most things were shut down for the night. It left a lonely feeling, like we were moving through a ghost town.

Eventually, we ended up at the hotel, which charges 1 Rand per minute of internet use. Hence, this note won’t be posted until tomorrow, when we’ll arrive at UNC’s Malawi House.

The end of the beginning

As of 10:25 AM this morning, I'm a second year dental student. On Sunday, I'm leaving (along with four other excellent dental students) for South Africa en route to Malawi. I'll blog every day that I have access to the internet, so stay tuned.