Weekend In Malamulo

Last weekend I visited our sister hospital at Malamulo.  One of their surgeons, Ryan Hayton, is currently on leave, and the other surgeon, Arega Fekadu, was feeling like he was being a bit consumed with the clinical load and not getting time to give attention to some administrative and academic responsibilities.  So he asked if I could provide some coverage.  Went down Thursday Afternoon, and came back on Monday.  Prepared two lectures for the residents, and had a good time interacting with them.

Also enjoyed the hospitality of Arega and his lovely wife, who made sure that Friday evening I feasted on Ethiopian food.  Simply delicious.

There were several things of interest.  First of all, it seemed quite remarkable to see five patients in the hospital at one time with the diagnosis of esophageal cancer.  Two were post-op.  One was getting ready for surgery.  One was unresectable and really needed a stent for palliation, but such was not available.  One was very cachectic and could possibly be a candidate if they could get her nutrition up a bit.  This is more cases of esophageal cancer than I saw during ten years in Nigeria.  It seems that Malawi has a very high incidence and our surgeons in Malamulo and Blantyre have quite a bit of experience dealing with this problem.  Could lead to some publications.

It is the beginning of mango season,  There were at least half a dozen kids in the pediatric ward with wrist fractures from falling out of mango trees.  Happens every year.  Not sure how to change it.  Kids will always climb for fruit.

Sunday morning we were asked to see a woman and her daughter who had both been attacked by a vengeful ex-husband/father.  Very sad.  The woman had been stabbed in the eye.  Miraculously, the eyeball was still intact, but the eyelids had been filleted, especially the upper one.  It was a bit tedious putting it back together.  The pre-op picture may not be suitable for posting on a public site, but here's how it looked after repair.

The daughter was stabbed in her left arm, deep into the biceps muscle.  Our second year resident, Dr. Kamwendo, repaired that one.  Very sad that a family can have such dysfunctionality.

We also had a man come referred from Blantyre with a high velocity bullet wound to his thigh that shattered his distal femur.  It was a robbery.  Fortunately he didn't injure any major nerve or blood vessel.  We took him to the operating room to clean out any devitalized tissue.  He should be a good candidate for a SIGN nail, and should get a good result long-term.

One of my favorite animals in Africa is the chameleon.  There are lots of different kinds.  The ones we used to get in Ethiopia when I was  kid were fairly small.  In Nigeria we had bigger ones, but they still looked "normal".  In Malawi there are chameleons with horns on their snout, almost like a rhinoceros.  I had only seen them in pictures until this weekend.  While walking to Sabbath School, I saw someone kick something off the sidewalk ahead of me.  When I got to where it was, it was this chameleon.

After being so rudely treated, he was not in any mood to be sociable, but hissed at me when I tried to pick him up.  Then he promptly headed up the nearest tree.  I didn't pursue him further, since I was staying at the guest house and wasn't sure what I would do with him.

Sunday evening I was invited again to Arega and Bikiltu's home for supper.  The fourth-year resident rotating from Ethiopia, Surafel, was there also.  Good food, good friends.  A very pleasant time.

I headed back to Lilongwe on Monday, stopping in Blantyre for lunch and discussion with Kirby Kasinja, the CEO, who also helps keep track of administrative issues at our health center.  Made it home before dark.  I don't like driving that road at night, and I had specific instructions from my wife that I should not be on it after dark.  So I was compliant.

Thursday morning I attended the surgery conference at KCH.  They still have no x-ray, no labs at night, and difficulty getting emergency and sometimes elective cases done, as evidently the anesthesia is not getting paid their overtime and are therefore being less than helpful (obstructive) at times.  For a country that doesn't have enough health care professionals as it is, it is even more unfortunate to seen them not being utilized well.  Which way the future?