Entertaining...

Well the start of 2015 has been nothing but eventful.  I returned back to Malawi at the beginning of January after spending time back in Brisbane for Christmas and family events. 

I have definitely hit the ground running and it looks to be an exciting year ahead.  My experience in Malawi, if nothing else, will teach me patience.  Nothing is done at  a fast pace except for crazy driving which in tuk tuks in wet weather over pot holes can get the heart racing. Combine that with the largest snail/slug suction cupped to your foot and you are in for an entertaining trip!

The earthquake hoax has to be one of the funnier events that have occurred in the last few weeks.  I was staying at friend’s house and we received not one but two phone calls warning us to prepare for the earthquake that is about to hit.  What does one do in this event?  Do you actually get earthquake warnings i.e. can they predict it?  We decided that sleeping in one room with things off the walls that couldn’t fall on us was our best option.  When I asked if any more news had been provided on the quake I was told yes between 10 and 11.  WHAT?? On the richter scale?!  No Beth it will occur between 10 and 11pm.  Needless to say these types of predications are impossible and no tremors were felt.  Another entertaining Malawi gossip story to add to the collection!

I have had some entertaining conversations the last few weeks with cultural differences and misunderstandings being the main culprit. One particular conversation that springs to mind is the need for the clinic to order soft and hard leather in order to make certain devices.  I asked my assistant manager to provide me with the dimensions of the sheets of leather we have used in the past to determine our order.  His reply was “Beth how can I possibly tell you that information I don’t know the size of the animals!!  I don’t know how fat or skinny they are!!”  So true my friend – what was I thinking?!

In speaking about animals a friend and I went to inspect a building office block that his family is having built.  We were met however by a tribe of goats who was led by their infamous male goat.  Hiding from him was entertaining and between the 2 of us we weren’t quite sure who was going to defend who.  A large stick was found to assist in our plight from Mr Goat should we have needed.

I am also getting to know the various tools of many trades. I can now for instance buy certain tools and equipment to weld bars for hand rails, purchase POP powder for plastering and now understand an engineer square (which by the way is not a square).

I have to say though that my highlight is still seeing the smiles of the clients that come through the door and the achievements they make (big and small) with their new devices.  A gorgeous 2 year old was recently fitted for a below calcaneous prosthetic.  In just 1 month her gait, hip alignment etc has improved immensely and I can’t wait to see her at her review in 2 months time. 

Yesterday a gorgeous 9 year old boy with cerebral palsy came in to the clinic.  He had various devices but had grown too big and staff decided they wanted to send him the surgeon for a calf release.  On further investigation and cuing of his gait he could with concentration obtain heel strike.  Deeper discussion with the staff they admitted that the child had KAFOs (knee ankle foot orthoses) and had progressed to AFOs (ankle foot orthoses) and there had been a significant improvement.  Suggesting we hold off on the surgery and see with better fitting AFOs and more structured gait exercises over the next few months before resorting to surgery maybe more beneficial.  We will see the outcome!

From a 500 miles perspective please have a look at our Big Dinner campaign www.bigdinner.co.uk .  It will be aired at 7pm on the 7^th of March UK time. Any contribution you can make will assist us in helping the disabled of Malawi walk more than 500 miles.

Kodak moments, Ebola and equality....

Another week or so has passed and I can't believe I've been here a month.

This week I've been wishing I could have been the passenger for all of my car trips to ensure I captured classic Malawi moments. Some include:

- the catch of the day hanging off someone's side mirror

- the older guy who travels with his push bike loaded up each morning wearing what looks like a crocodile skin akubra

- the 2 mules walking down the middle of well to do suburbia that I almost ran over

- my bicycle taxi experience

At work I wished I'd pulled out my camera sooner to catch the smiles of the cerebral palsy kids who weren't afraid of the azungu (white person). Or the look on the face of our clients who are walking with a prosthetic for the first time. Or the look on my face when I get asked to be involved with the management of gait training for someone using a prosthetic for the first time. Camera permanently attached to me may need to occur!

In a society where things move at a snail pace (except for those driving who need to get everywhere in a hurry with no requirement for road rules but once they get to their destination things can take a life time), it allows you to take time and assess. 

This week I attended a lecture on Ebola and what processes need to be potentially put in place should it ever reach Malawi (touch wood it never does).  Resources are so limited but the enthusiasm of the staff and the verbal commitment they essentially made was empowering. 

I heard of the Sydney issue this week where one crazy individual held many innocent people hostage in a chocolate shop. That in itself is a crime!  What rang true for me was that regardless of where we live there will be and continue to be more cultures, races, religions of which we can all learn from and embrace to create a diverse society.  What a situation like the issue in Sydney does is highlight the need for more education, involvement and understanding with in our changing society wherever we live!  This man's actions don't define a race, religion, culture etc but rather determines this man's need for help.   

Whilst not the same context, here in Malawi and in my role at our clinic, I feel it is our need to ensure that education, involvement and understanding of those with a disability in a country like Malawi where the disabled are shunned, is so important.  This can simply begin with a hello, an interaction, a handshake. Showing to the wider community that acceptance of those who are different is a step in the direction of equality. A road that still needs to be travelled.  It is but a drop in the ocean but if each individual can start small imagine the impact. Dream big!

Acceptance...

Moving to another country is one thing.   Being accepted by that country and immersing oneself into the culture is another. Working out acceptances within that culture both as a tall white female as well as working with individuals with disabilities who are shunned from society is also an eye opener into the human psyche.

During my second week I wore a chitenji (African patterned fabric - worn like a skirt) to work.  There were a few comments from the staff that I couldn't quite catch.  When I asked one of the female staff members what was being said she told me that I had done a good thing wearing the chitenji.  I had been placed in a higher regard and was more accepted by the staff.  Note to self wear them more often!

We are currently having Chichewa (language) lessons.  The more often I use basic words the more engaging I find the staff and obviously the clients that come through the door.  It is critical to at least attempt some form of cultural understanding as culture can be a secret weapon that can make extraordinary things happen.

Life in another country always has its interesting and challenging experiences as well as it's 'gold' moments.  This week's gold moment I was trying to practice my Chichewa and in English the sentence was 'My problem is in the shoulder'.  I was quickly told to ensure I say shoulder correctly as I had just said a significant profanity but the information was not divulged as to what I had said just to ensure I never say it again. I was definitely the imbuzi iwe azungu (idiot white person).

I also have almost killed multiple individuals this week.  Road rules are not something that is followed well however you will be beeped at often.  Usually if you are obeying the road rules i.e. stopping at a stop sign or red light!! I need to be careful when I return to Australia!  If only I had a camera whilst driving.  The sights one sees on the back of the bicycles, trucks, cars etc. Many a priceless moment that could only truly be captured by a photo.

On a work perspective seeing amazingly challenging and complex conditions on a daily basis is what I can't wait to get more hands on with.  Whilst my role is predominantly managerial I want to ensure I keep touch with the amazing and challenging conditions so many people face that we in a developed country just don't see or hear about.  The thirst for medical knowledge is shining through.  I am up for the challenge :-)

Firsts for everything....

I think it's going to be 'firsts for everything' for a while yet!  This week's highlight was riding in a public minibus (van). A mzungu (white person) riding in the bus who is too tall for the bus both in height and leg length raised some eyebrows. Malawians love to talk with their eyebrows! To ensure a 'safe ride' one must crouch  and ensure minimal pressure is applied by ones knees to the seat in front to ensure decapitation of the head and knees does not occur. For my 150 Kwacha (~25-50c) I got to my destination safely. The challenge next trip is to increase the number of maize bags and people. 15 people in a 10 seater van is pretty impressive!

Management is a whole new ball game in Malawi. The idea of a plumber coming with his own materials that you don't supply is unheard of. But I thought your services were covered by the hospital maintenance? Yes they are just not the materials! So I now have to take the plumber to buy the materials?  Why Beth of course!  I now know where to by a bend pipe for an external loo pipe and some basic 'cement glue' to hold it in. Next stop just change it yourself! I've never seen a plumber just turn up with 2 screw drivers!

Whilst I'm still getting my head around my role and batting my eyelids appropriately I do get excited when new and never have I heard of conditions come in. I'm looking forward to getting my clinical hands dirty. Eg PFFD (clinicians look it up). Basically a congenital deformity where the big leg bone (femur) doesn't form or grow properly. Apparently quite common here. Research paper I hear you say?!

Today I got super excited when a man in a less than standard clinical wheelchair came in with his possible nephews holding his broken leg up in a chitenji (cloth). At a closer look I realised it was externally fixated. The amazing thing is he had come with X-rays. Let me at them! It turns out he had a break in his femur and 2 breaks in his tibia/fibula. In lay terms this leg was not too crash hot and his nephews were holding it up to stop it moving as they wheeled him around the hospital grounds. Given that the lift is broken I hate to think how they got him down the stairs.  I was confused what they wanted us to do. The orthopaedic surgeon had sent them down for a temporary cast/brace until they decide to go in and fix the remaining bones. I beg your pardon?! What?! Isn't that your job?! Ummmm lets consult the surgeon! Tomorrow's agenda!

Where I am currently staying is a bird watchers paradise. Who knows what kinds of birds they are. Look out....bird nerd emerging!

This weekend challenge is to find the gym and socialise. This normal hour work week is so exciting! Don't speak too soon Beth...

Beginnings...

The trip over was not as exhausting as first anticipated.  I ended up having an interesting Thai massage with a somewhat different hair playing experience. We'll just put it down to when in Thailand…

I hit the ground running on Tuesday when I arrived at the clinic.  Introductions all round.  The balance between ensuring my place within the hierarchy of the Malawian medical system, the hospital as well as ensuring that I manage effectively the team at our clinic will be a fine balance.  Learning the cultural innuendos, nuances etc will be a challenge but I'm already looking forward to immersing myself within the cultural and the system.  Whilst my skills as an exercise physiologist will be somewhat different to the prosthetists, technicians, bench workers and managers in the past I think it will bring a great dimension once we hit the outreach clinics next month. Of which I am looking forward to.  Enhancing my skills in the area of amputations, birth defects etc as well as learning to be an effective, positive and enthusiastic manager are all elements of life in Malawi that I can't wait to explore.

Time is of the essence here in Malawi.  The more time the better.  Things are not done in a hurry but it is all part of the process.  I think this will be a challenge in patience and 'being in the moment' for me!  Building new relationships, processes, clinical reasoning as well as new skills bring an element of excitement.

Whilst some challenges will be exciting others will be frustrating and significantly Malawian.  First 48hours brought this… no hot water, no water, no electricity, broken tap washer tied on with old bicycle tube. Nothing but entertainment here!!  Stay tuned for more fun :-)

48 hours til departure

This is getting real!

Hand sanitizer check.
Red dirt resistance clothing check.
Chichewa language book check.
Sense of adventure - of course!

I have been overwhelmed by the support and encouragement from friends, family, colleagues and people I have only recently met.  Whilst I appreciate that this is not everyone's cup of tea and many would not embark on this adventure, I do acknowledge that I have been able to assist in changing individuals thoughts about what else is out there.

Wednesday night I presented on behalf of Exercise & Sports Science Australia (ESSA) a webinar entitled AEPs (accredited exercise physiologists) within a minority setting.  We discussed the challenges we as allied health professionals will potentially face within Indigenous Australia, multicultural Australia as well as in environments and communities such as Malawi.  The need for cultural understanding, sensitivity and awareness.  About the need for mutual respect, an ear to listen to and an appreciation that our health beliefs, experiences and understanding are all different.  A challenge that continues to grow the more we immerse ourselves in a different culture and health setting.

The next few weeks will be an exceptional challenge both professionally and personally as I develop a better understanding of 500miles and the services and clientele we will provide to.  I am looking forward to sharing my experiences with you all.

Tionana (see you later)

2 weeks til the adventure begins...

2 weeks until I jet set again to beloved Malawi. Basic packing is done and the final necessities being purchased before I leave on the 16th of November.

I'd like to take this opportunity before I leave to start the push for our big fundraising dinner for 2015.

500 miles is hosting 'The Big Dinner' on 7th of March 2015 and you too can get involved.
Our goal is to raise £500 000 in a single night to assist with providing more orthotics and prosthetics to the numerous people we will see at our clinic in Lilongwe, Malawi.

Go to http://bigdinner.co.uk/ to find out more about our big event!