Hi everybody!

Thank you all for your messages, it is nice to hear from home!

Since my last entry I spent two weeks working at zomba central hospital, and have been travelling since then.

Zomba hospital was much better for me to work at than Queen Elizabeth in Blantyre, because I was the only medical student in the department. It is a smaller hospital with only one gynaecologist for about 100 women. Lots of acute and complicated cases are referred from the district hospitals.

The german gynaecologist there let me work very independently...it was really a great experience to realise how much I can (after 5 years of med school...) actually do on my own. I have really learned to improvise here, because they have always run out of something (gloves, masks, antibiotics, drains...etc.)...I can name at least 6 uses for a catheter :-). If you want something done here for a patient you have to do it yourself, because asking someone to do something in no way guarantees that it will actually get done....even when patients are very sick and need attention. Many people die here not due to lack of resources, but due to lack of communication, which is very sad and frustrating. Whether nurses here are afraid to call the doctor, too busy with other things, or just lazy...I haven't quite figured it out yet. Because the maternal death rate here is so high, all attention during a delivery/caesarian goes to the mother to prevent complications, the baby is put in a bed somewhere as long as it's breathing. They are doing their best to take care of their mothers. I attended a very good training with all the midwives in the hospital on emergency obstetric management. The problem is that the midwives from the district hospitals don't attend.

In the operating theatre I have learned a lot...one scrub nurse was 6 months pregnant and the other had 3 jobs so they both had a tendency to disappear halfway through an operation to go sit down, which made me both assistant and scrub nurse at the same time. Also the midwives kept disappearing during ceasarians when the baby was about to come out (usually if we yelled 'midwife' loud enough one came running from the other room before the baby was actually there). I also did operations with young clinical officers who really had no idea what they were doing (and of course neither do I), but usually everything ended up ok. I worked a few night shifts in the labour ward. I ended up sleeping (never for more than 20 minutes...) with 4 midwives on the floor behind the booth in the labour ward on 2 matresses. It is amazing to see how well the family takes care of patients. They camp outside the hospital the entire time a patient is admitted, and they cook and wash for them (because the nurses don't have time to). At 4:30 in the morning the postnatal ward was bustling with crying babies and grandmothers/sisters/friends taking care of the women.

Enough about the hospital...A few weeks ago I travelled to liwonde national park;it was the day after I was on night call so I fell asleep in the canoe just as 3 hippos put their heads above water (luckily my friend kloe woke me up). It took us 2 hours to cook dinner because there was no electricity and we had to build our own fire. In the morning baboons had raided the kitchen. We went on a game drive in the morning and saw lots of elephants, buffalo, and monkeys.

Last week we went to lake malawi. We rented a car and I drove, I had never driven on the left before, and the minibus drivers here are nuts, and there are lots of potholes in the road...but by the way back I was thouroughly enjoying the driving. It certainly beat being on a bus that stops every 5 minutes with the fish, chickens, and 100 other people! Lake malawi was beatiful, and it was great to relax on the beach for a few days. We went snorkelling at one of the islands, we had to canoe to the island in a wooden canoe that was impossible to steer, so it took us a while, but it was worth it in the end.

This week we went to Zambia on safari and saw lots more animals... We had about 6 encounters with elephants on the road that didn't want to let us pass. They get a bit scary when they flap their ears and make noise 2 meters from your car, although usually they seem very peaceful. We were woken up every morning by the sound of hippo's in the river just outside our tents, and once an elephant walked into the camp just as we were about to go to bed! We also saw lions 3 times up close. The night drive was not so successfull, we saw two rabbits, and were attacked by all sorts of bugs that were biting us the whole time. I am very proud of Kloe and Yvonne who are scared to death of insects (every time I hear them yelling my name I know it is to get rid of a spider for them...) who did their best not to complain. Zambia is less populated than malawi, and the nature is stunning. Especially now that the rainy season has started and everything is getting greener by the day.

I am spending my last 2 days in blantyre...I will be home on thursday :-)

xx

Dina