Feeling teary

Our last night in Malawi and I think we all have mixed emotions. It’s been an amazing adventure. We didn’t make much of an issue of it here (no sense in worrying those of you at home), but Iris was pretty sick for a while mark knew exactly what was in store if we had to check her into a hospital, and that was pretty scary. And yet, we know that we always have the option to hire a car to a big city, or fly to South Africa if an emergency arose. Every day, mamas here have to decide whether to pay to ride on the back of a truck to take their sick baby to the health center, or buy food for their family.
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many of you have asked me to weigh in on what this trip is like with small children. Would I go back and do it again? Yes. BUt there are a few things I would like to do differently.
1. A cell phone would have made things much easier. I would also consider a dongle, which would allow you to have an Internet connection wherever cell service exists (which seems to be just about everywhere). Internet connections were few and those that existed were expensive and very unreliable.
2.  I’d bring more drugs. Even with mark’s careful planning and what felt like an entire mobile pharmacy, we still felt like there were drugs we wish we had access to when Iris was sick. And yoU won’t find them here.
3. I would have felt much safer if we’d been able to spring for a car rental or taxi instead of minibuses and matolas everywhere we went. BUt the price difference is phenomenal. Example, the 18 km from the main highway to the beach town was U$35 by private car, U$8 by matola. We lugged carseats halfway across the world for one car rental. Most transport around here doesn’t give yoU your own seat, much a seatbelt.
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We will miss the amazing places and the friendly people here in the ‘warm heart of Africa.’ We’ll not forget the intensity of color, smells and sound, and the density of vegetation and people. As mark said, this place gets Under your skin. I have no doUbt we’ll be back. And next time, we’ll make sure we have more than six weeks to contribute to and learn from these wonderful people.    

Tea Estates

;As much as I love public transport, we went crazy and sprang for a car rental this week to visit mount mUlanje. It’s a tall granite mountain and at the base are acres of tea estates and all I can say is wow. It might go down as one of the most beautiful places I’ve ever seen. 
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;It’s quite remote. The villages are farther between than the rest of Southern Malawi and the roads were rough. Every direction you looked gave a different incredible vista. It was sort of like a lush, green, exceptionally beautiful New Mexico, and I’m rather partial to New Mexico scenery.
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;Part way up the mountain is a church-run retreat. It is set next to a river with boulders that create deep swimmable holes and it lies under huge cedar trees. The  food was good and the staff was friendly. The only disappointment was that we only got to stay one night. UI would definitely recommend several days in this amazing place.
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;PictUres to come soon...

wrapping UP

Until the late 1970s, the capital of Malawi was the perfectly beautiful town of Zomba. This picturesque town is set at the foothills of lush, verdant mountains and the hilly terrain is drop-dead gorgeous. Now this is a place that makes sense to make the capital. The weather is breezy, cool in the shade, warm in the sun, and the hills would whip your calves into shape in no time.

BeaUtifUl Zomba

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Our home for the night was a rather uninspired hotel in a beautiful setting. Warning…rant. Malawi really is crazy expensive. Our hotel was UUS$100 per night, a price I refused to pay and negotiated to half that. But still. The linens were tolerable on the twin and double bed, the shower barely had any pressure, a naked bulb hung from the ceiling, the advertised TV and wireless Internet didn’t work. Seriously, to whom are these places catering??;

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I complain aboUt minibUsses, bUt at least I'm not riding on this.

On the minibus one last time (insert little happy dance here) to Blantyre. Actually finding it to be a cool city with lots of beautiful panoramic views of the mountains, an active market and a plethora of eateries. Prices astound me. Our UsU$35/night is getting Us three twin beds with semi-clean linens, a partially functioning bathroom in a downtown location. Cockroach visits throughout the day are free. We thought we’d move on to a nicer place after one night, but we’ve visited every hotel within walking distance that we can find and they are all USU$100-200/night.  Those Under U$185 classify as slightly yucky.

Press yoURself close enoUgh to the wall to feel the drizzle from the shower head and yoU risk pUnctUring yoUr abdomen.

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I was warned that Malawi was expensive, but UI have been overwhelmed at the cost of living here. With gas at USU$8.00/gallon (if it’s available…there are frequently hours-long waits at the pumps) and some of the lowest per capita income in the world, I mourn for the Malawians. I’ve not met warmer, more gracious people, and UI don’t know how they make it. Food costs are nearly identical to those in the US, sometimes higher. At least my weaknesses for avocado and mango are cheap here.

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Signing off for a bit. Iris is yelling ‘Fanta! Fanta!’ which must mean the addiction is official. I also overheard Grant talking about how Iris' gyrating belly reminds him of the Lady Gaga video he saw three nights ago in a bar/restaUrant. Yikes--mUst go investigate this. 

Hippos, hippos, hippos

What’s large, wet and laughs like a big fat man? Why, a hippo, of course!

We got our fill of hippos on our second trip to Liwonde National Park. This time, we went all out for an overnight boat trip and we were not disappointed. Really, I could get used to someone cooking delicious meals for me on the comfortably equipped mangUnda. Other than the fact that our South African host and his crew smoked like chimneys, it was an Utter delight.

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The hippo concentration in the Shire River through Liwonde is the densest in the world (or so they claim) and it was pretty fantastic. On either side of the river they snorted and laughed and bellowed. Many of them were even on land and they would lumber back in the water quickly as the boat approached. They are surprisingly fast for their rotund awkward-looking frames. Iris excitedly exclaimed ‘heepoosh! heepoosh!’ ever 90 seconds or so.

Birders would be absolutely beside themselves in this place. Impala, monkeys, crocodiles and waterbucks abound.

The kiddos were thrilled at the idea of sleeping on a boat, and we all enjoyed a virtually mosquito-free night (being anchored in the middle of the river – no sleeping Under nets), listening to all the entertaining hippo sounds.

On the mangUnda

We saw three herds of elephants the second day, but none close enough to get a very good look. Ah well., an excuse for another trip. There are big cats (lions, leopards,) in the park as well, but it is so lush they are rarely seen.

Maternity ward

So my time on the maternity ward was cut severely short with Iris’ illness and the need to catch transport early.  In addition, I was disappointed that I did not deliver any babies but in fact none of the doctor’s deliver babies unless it is via c-section for complications, of which there are many.  Birthing is largely done without direct oversight and with a circulating nurse midwife who is very busy. Women in Malawi have a 1 in 36 chance of dying as a pregnancy complication over their childbearing years. Phenomenally high and important given the number of births per month at this hospital (between 700-800 —roughly 3x the volume at women and children’s hospital in Columbia). I have three children and never once did I fear for my wife’s life or did it even occur to me to have that concern. In fact, I feared more for my own by pointing out when her clothes weren’t fitting as well—a bonehead move that perhaps one reader will avoid in the future.

            The ward is arranged with a post-partum c-section Unit, a general medical bay for women who are pregnant and ill (with conditions both related and Unrelated to pregnancy), a small neonatal Unit with one incubator, a high-acuity room for women who have had severe complications such as a Uterine rupture, and a kangaroo care bay for children who were born prematurely and weighed less than 2000gm (for those who can’t picture this, they can fit in your two outstretched hands easily).

Didn't want to be insensitive and take pictures of laboring women. Here's some cute kids outside the hospital instead.

            The number of women in the post-surgical Unit was easily over 50 and they shared a bed with another mother and the two new infants. Many women did not have a bed and so we examined their abdomens on the floor and ensured they were not fevering post-surgery. The general medical ward was the same with no fewer than 40 pregnant women lying on a concrete floor, many traveling long distances, waiting for their problem to be ‘severe enough’ to warrant a bed. Beds were for those who were vomiting, dehydrated or had very high blood pressures or pregnancy-threatening conditions. Those not lucky enough to have a bed were seen all at once on Wednesdays to see who had gotten worse. The thought crossed my mind that it seemed women had quite an incentive to not be pregnant here and also I thought about the kind of revolt that would occur in the states if we told our women to lay on the floor or share a bed with another new mother and infant. Also, how different for a child to enter the world in a Unit that looked like a war zone-(plywood dividing the labor beds) compared to our single rooms with TV’s and foldout couches for dad.

            I don’t want to ramble on so I’ll just say that it made a huge impression on me and if I was to return, this is definitely the area of highest need. There is an entire clinic chain dedicated to reproductive health and I think working there would be eye-opening into the choices that both men and women are making (and not making) about family planning.  We are all still doing well and I am beginning to have stomach pains thinking about the flight home.

Babies and Breasts

At home, I consider myself a resource in the areas of breastfeeding and baby wearing, but I am getting schooled here, that’s for sure.

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Every Malawian mother breastfeeds her babies and it is a regular occurrence to see toddlers nursing. Even HIV positive mothers do so. The medical community demands that a woman undergoing antiretroviral therapy breastfeed her baby for a minimum of two years. I had a conversation with the interns at the hospital about the rates of breastfeeding in the U.S. and they were appalled.

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mark witnessed one tired mother in the hospital dozing next to her squalling newborn. The attending physician walked over, whapped the mother on the arm, pushed the baby Up to mom’s breast and admonished ‘Feed that baby! Look, you have huge breasts filled with milk. It is for your baby, not for you!’

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I have seen one stroller since we arrived in Malawi. I saw it everyday in a stall at the market when I was shopping for meals. It never sold in the month we were in mangochi.

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Amayis wear their babies in their chitengas, a fabulous piece of cloth that is worn as a wrap-around skirt, blanket, dress, baby carrier, and more. Sometimes older siblings wear babies. More than once, I have seen a ‘big’ sister or brother carrying a sibling that had to be more than half her or his size.  

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;As UI anticipated, this trip is turning out to be quite the cultural exchange. It has certainly taught me that we don’t put nearly enough responsibility on our children at home. As soon as we’re stateside again, I’m putting Grant in charge of all food preparation and Lydia is taking over baby care. Iris will be responsible for all the chickens I plan to acquire. She’s quite enamored with the ‘Uncucus.’’

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;I love this sign from the mangochi hospital outside the laboring ward. I’d love to see something similar in the States, though the all-powerful formula lobby would surely find a way to get it removed.

Gone north

We have said ‘adieu’ to mangochi. It was a fabulous experience, but all of us were ready to move from the heat and on to a new adventure. We managed to find a ride in the back of an ambulance to Cape maclear, a major improvement from traditional Malawian transport.
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;We are lazing at the beach, soaking up rays and enjoying the hammock. It beats sweating all night in our 92-degree airless room in mangochi (though that would be a close second, of course).  We love the beach village lifestyle. Families come to the water multiple times each day to wash dishes, swim and bathe. There are always a slew of naked Malawian children splashing about.
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;We took a short boat ride to a nearby island where we got to snorkel among the world renowned cichlids of Lake Malawi and enjoyed a delicious meal of fresh fish cooked over the fire.  It doesn’t get much better than that.
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;I apologize for the great silence on our part the past two weeks. Lydia had serious intestinal distress for a few days, and then it hit little Iris. It’s taken her a while to recover, but she is finally herself again. And, now that we are on the beach with a lovely breeze, she is finally heat rash-free for the first time since we arrived in mangochi.
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;Our computer is on its last legs, I’m afraid (note the weird Uncorrectable typos in my text), so we will do our best to stay in touch the next two weeks.