Tribute to Arnol

3weeks’ worth
It’s been hectic since I left this blog last. To try and recount all these events would make it far too long, so I shall simply summarise them and expand on a few. But before I do anything, allow me to pay tribute to a newly-met VSO friend of mine, who succumbed to a fatal road traffic accident on his motorbike only days after the annual conference: the exceedingly nice Arnol Pajaron, VSO volunteer from Phillipines who was working in Secure Livelihoods towards agricultural improvements in the district of Thyolo. May you rest in peace Amigo.
This was very much the first event since the conference. Sadly so, because I met him there. During the week that followed, I also undertook my last week of orientation at Kamuzu Hospital. This was mostly a week of wrapping up and refining some of my skills acquired so far- amputations, debridements, hydrocoelectomy, as well as clinic work. The visiting Orthopaedic surgeon, Sven Young, left at the end of that week, leaving the department without an orthopaedically-trained doctor anymore.
On the weekend, I went to Blantyre where a memorial service was being held in honour of Arnol. It was a truly moving service, where the close-knittedness of the Filipino community and their generosity were revealed at their best. The wider support of VSO was also evident, with more than 40 of us travelling from up and down the country. Probably the most humbling part of the service came from the very people Arnol worked with, the farmers, who also made this difficult trip to Blantyre just for him. The rapport he had developed with them and the fruits of his hard work were obvious from the brief but honest speech they did there. A slideshow of his time in Malawi, compiled by his best friends, concluded the service, with most of us struggling to hold back tears.
After this rather traumatic patch, my next week started afresh with a rather peculiar training for an orthopod- Anti-Retroviral Therapy provider certification (ART). Peculiar is starting to look like the norm now for me at this rate! ART is seen as being beneficial for anyone on the delivery side of health care in this country as I should hope “to become a player in the efforts to bring down the HIV/AIDS epidemic”. I use this very turn of phrase here to highlight a major division that manifested itself uncomfortably to me during the course: the cultural divide between Malawian and VSO participants. There is something that VSO volunteers very often talk, in fact, moan about, and maybe understandably so. It’s the allowance culture. Many key health care staff we work with are often absent from work, under the guise of such and such course. They get paid a hefty bonus (given as incentive) and generous living expenses for going to the courses. It often happens to be the same people who tend to go away on courses, such that they’re away getting trained rather than putting that training into real practice. The striking difference between “us” and “them” screamed out when we all got asked to express our expectations from this course at the start. Quite puzzlingly, the principal points raised by the Malawians were to do with their “accommodation”, “food” and even “allowance”. So, one of the VSOs finally added that we were also here to learn and develop our skills or something like that and I came up with the aforementioned quote! What tipped the balance of hostilities though was a complaint from the Malawians, who were being put up in a not-bad-at-all establishment. They found that room sharing was unacceptable, the water supply not good enough and the tea cold! This didn’t go down well with one of the VSOs who answered them back saying “they should stop complaining and get on with it like the rest of us are!”. This was a difficult one as that VSO would clearly not have interjected in such a way had some westerner raised this complaint in the west. Yet, given the economic situation in Malawi, having such high standards for educational meetings appeared to be somewhat eccentric. Point taken but still most of government meetings take place in one of the high-end hotel chains (which, I discovered, is owned by the government, hence attracts a massive discount) and civil servants want to have similar privileges. As for the allowance side of things, again I find that difficult. On the one side, I have depicted how they can represent a financial drain on institutions rather than a gain if the designated trainees are too frequently away on training. However, I also sympathise with them a bit as indeed, this is the only way they can acquire more skills to operate at a more advanced level, as required. Most won’t have had the privilege of a university education or tertiary diploma. Also, saying that they’re most of the time away on courses is probably an exaggeration (based on other volunteers’ experience), which I’m yet to assess for myself once I’m settled in my job. Regarding the financial reward involved in attending courses, one can hardly blame them, if one only looks at the gulf between their actual wages, all allowances included, and ours in the west (not our stipend here which is largely unrepresentative). Finally, there is a real problem here in the form of brain-drain of talent, as the highest skilled Malawians are often recruited abroad or in non-governmental organisations, leaving the government ones like hospitals starved for qualified staff. How can one blame the government on the one hand for not remunerating the staff well enough to ensure retention and, on the other, for giving them allowances to boost their wages? One is tempted even to congratulate them for attaching the financial reward to an actual educational activity rather than simply raising wages. Everything in perspective I think and whatever judgement be made, it ought to be made with due consideration of all relevant nuances. After the uncomfortable start though, the week eased off with some lighter humour and me acquiring the honorific of “Aphiri” probably for making sure I stayed neutral in that original rift. The amount of new information being force-fed into my brain was phenomenal, considering how detached I had become over the years from virology and infectious diseases (being married to a microbiologist unfortunately didn’t impart a chip in my brain with all this wisdom!). So the test in the end was something I was seriously apprehending. Thankfully they made it easy enough even I cleared it. So did the whole class!!
On this end-of-week note of success, I took myself down with some other vols to a bar in the capital city to watch the first of my Malawian music gigs. The band was The Black Missionaries, one the most popular bands around and they were supported by Anthony Makondetsa. Both were quite groovy, with a very typical Malawian beat to them (that one that unfortunately resonates every night on my bedroom floor in Ntcheu!) The crowd was equally interesting and I automatically made friends with some locals who were loyally ensuring my enjoyment throughout. There was none of this uncomfortable pressure of asking for things which I really like with Malawians. If anything they might ask for a beer maybe in exchange (which I would have offered anyway) or the chance to associate with the muzungu female company I was with (which of course, I had no control over!).
Next day, Saturday, was a memorable day as I finally set my bearings on Ntcheu for good, without any more orientation or training to do elsewhere. The settling in was invariably coloured by my very own priorities. Noise reduction and kitchen sorting strategy before house furnishing. I’m still working on both at the moment but hopefully will find a right balance. The location is simply great and it would be a shame to have to move. On Sunday (Palm), I went to my flatmate’s church out of curiosity and also because I knew a few people there from my short in Ntcheu already. It was an mind blowing experience to say the least. The church is a Born Again Christian one and the praying style is very much one of intense singing and going into transe, somewhat intoxicatedly. Also there was a strong focus on fund-raising (remember that previous do I went to? That was this church’s bishop’s wife). They had just acquired a set of drums and now wanted to get a keyboard. They pride themselves about having built everything themselves including the church building and essentially want to keep on upgrading... To get some balance back, that afternoon I saw my first ascent of the Ntcheu mountain with some other vols. It was a most rewarding experience, a mini-breakthrough in that it seemed like the rainy season had finally made way for some dryness. Unfortunately we were proven wrong from the very moment we began our descent... The view from the top alone would justify the climb and it took us less than 4 hours, so not too much of a pull for my aspiring visitors. Ntcheu Mountain Kids From the TOP
That done, I finally began working as a proper doctor IN Ntcheu district hospital this Monday gone. Hooray! It certainly feels like a big step forward for me with my numerous new roles and responsibilities waiting to be discovered. My job description is exactly defined and, for the rest of the week, I’ve been trying to find a way of making optimal use of my skills for the whole hospital. I have to, at once, try not to overlap with the other 2 doctors there, one obstetrician/surgeon, and 1 paediatrician (no problems there), and bear in mind that I will probably inherit some of the workload as they leave 4-6 months before me. Simultaneously, I’m also getting working on this project for which I got given a grant by VSO. I was exceptionally lucky to get this at such an early stage, and I’m going to use it to upgrade the orthopaedic department (ie replace rusty blunt instruments with one that cut). My clinical digest for this first week includes several Orthopaedic ward rounds and clinics, with little surgical work, except for assisting in an inguinal hernia and a Caesarean section.
The week ended up nicely at the DHO’s (district health officer- aka hospital chief) house on Thursday night, early start of the weekend courtesy of Easter. He is a 26yr old doctor who finished medschool 2 years ago, but is now looking forward to resume proper clinical duties once his term finishes next month. What started off as a few quiet drinks evolved into a full on night out, with us hiring out a minibus with driver (sober) to take us to the next town for some concert action. The big man from Balaka himself was performing on his home turf- Lucius Banda. So we couldn’t miss it. The socialising with locals was very much identical to the Black Missionaries do, but our own company was completely different. Loads of hospital staff- COs, medical assistants, doctors- and some non-medical people, the whole lot numbering 12. The one that stood out was the anaesthetic CO, who decided to hit on one of our female VSOs. Of course, he was married and she clearly indicated she was attached too and not interested, but the very fact she was chatting back to him nicely earned her the honour of being his girlfriend for the night... at least until it was time to get dropped off back home and hey presto, who was awaiting at the hospital gate?!!! None other than his fat angry wife, who announced her discontent by stamping solemnly into a water puddle before charging onto our bus. Little did our man know that she was not rushing in to join him onboard with loving cuddles, but with a vicious grip to drag him out! Ouch! As for the rest, your guess is as good as mine.