Elizabeth goes on Med Hold

So in the two and a half weeks since I arrived at my site in Chiwamba, I have been sick all but about five days. It started as a cold, which morphed into a coughy- tight- chest thing. Being sick is no fun when you have to draw your own water and cook over fire- no spending the whole day in bed! Plus it was frustrating to finally be somewhere where I could actually do something and instead feel too weak :-(
After starting on some antibiotics last week, I felt better for long enough to walk out to some of the nearby villages where the HSA's were doing child nutrition campaigns. I helped measure children to screen for malnutrition while the HSA's gave out vitamin A and mebendazole for worms. We were able to identify several malnourished children who were then referred back to the Health Centre for supplemental feeding. After about three days of this, though, I started feeling crummy again. Two nights ago I had a fever and called the doc bac, who had me come into Lilongwe first thing yesterday morning.
I hitched out from my village to the main road with some missionaries (thank you!!!) and rode in the back of a truck into town (not fun- we were stopped at a police checkpoint for almost an hour...). The doc found me lying on the steps outside the clinic, out of breath. Some new meds and a bit of IV fluids later, I felt a little better. I told the doc that I hadn't eaten in two days and he took me out for a milkshake!!
So I will be in Lilongwe for a few days until I am fully recovered.
And then....hopefully....starting actual work in Chiwamba...

The Third Day in Chiwamba

On the morning of the third day at site, I was woken up by a gaggle of kids outside my window.

            “Eliza!, Eliza!”

            They were yelling something else in Chichewa that I didn’t understand. I looked at the clock- almost 6am. I should be getting up anyway.

            “Mwadzuka,” I yelled back out the window- “good morning!”

            I pulled on a Chitenge and fumbled with my keys. When I got outside there were 8 children beaming, including one boy bursting with excitement. He was holding a terrified hedgehog, which he then pushed into my hands.

            “Where did you find this?” I asked, as I sat down and let the hedgehog uncurl and crawl around on my lap.

            “Alipo,” he shrugged- “just around.”

            I had seen a hedgehog before in Mkonkera, and was told they were very rare. The hedgehog woke me up well; 90% prickly spines, 10% fleshy belly, with a long nose and black bead eyes. I gave it back to the boy.

            “I have something to show you too,” and I dashed inside.

            The day I had arrive in Chiwamba, to a house that had sat unoccupied for several years, was a blur. I was helping to sweep it out when I spotted a bat clutching the wall. I yelled to my neighbor, who hit it with a broom handle and carried it outside. When we finished sweeping, I went back to the spot where we had cleaned up massive amounts of droppings and looked up. There were dozens of bats sleeping on the backside of a rafter.

            With the squeaks and the droppings, I had assumed that my house was infested with rats, so I had loaded up on rat poison and traps in Lilongwe, but I had no clue what to do with bats.

            “Watch out,” my neighbor said, “ there are a lot of nyerere.” Ants. Biting ants I would soon find out.

            The bat room was where I had been planning on sleeping, so I moved all of my things to one of the back storage rooms. By the end of the day, I would be carrying water from the borehole and scouring my new bedroom, only to find that no amount of elbow grease could remove the years of grime on the cement walls.

            I decided to heat some water for a bucket bath, but I couldn’t light the charcoal. I soaked the briquettes in paraffin and fanned the tiny flame until my arm cramped, but the water only got lukewarm. I took a lukewarm bucket bath and went to bed.

           

            On the second day, I knew that I had to do laundry. I hauled a 30 liter bucket filled with dirty clothes to the borehole and started scrubbing.

            The borehole is a great place to meet people, since it is on a major path out to the maize fields. I greeted everyone who walked by in Chichewa, often explaining who I was and what I was going to be doing in Chiwamba.

            “You wash your own clothes?” Many people asked, “Who taught you do to that?”

            I realized as I finished that I didn’t have a clothesline yet. I had to dig though the endless bags of supplies from Lilongwe to find it. I had to move quickly-I was going to be late for a staff meeting at the health center.

            The five minute walk from my house to the health center turned into 15, as I stopped to greet a group of local chiefs. (“You always, always have time to greet the chiefs,” I had been told in training.) Of course the meeting started an hour late, so I shouldn’t have worried.

            Every few minutes, the head of the clinic would pause the Chichewa and ask me in English if I was following what was being said, then give me a big high five if I answered correctly. We laid out plans for my first few work days next week, observing some health workers in the field who were conducting a village assessment. After the meeting, there were still several hundred patients to be seen in the clinic, plus dozens more in antenatal, since the nurse was out for the day.

            “Come on,” the Medical Assistant grabbed me, “there is a woman bleeding.”

            I know that as a Peace Corps Volunteer I cannot do hands-on care, but the nurse in me rushed to see what was going on. A woman was lying on the delivery table, moaning. She was five months pregnant and hemorrhaging. I could smell the blood. Someone had already called an ambulance, and it pulled up just as we entered the room. Malawian ambulances are just cars with one driver, however, and the drive to a hospital would be at least an hour.

            “Can you start an IV?” I asked the MA.

            “Lets just get her in the ambulance and go.”

            We moved to the prenatal exam room where I observed a basic visit. I felt the belly of a very pregnant woman. In nursing school, I always had trouble finding the lay of the baby, but on this slim Malawian, I could feel the curve of the head, the shoulder, even a leg as it moved. The mother smiled.

            Suddenly there was a gasp outside. While the bleeding woman was being carried out to the ambulance, she had given birth. The MA ran out to help, and I started praying under my breath. I gave them a minute and then ran out to join them. I didn’t want to get in the way.

            “Is it alive?”

            “Yes, for now.”

            I looked though a tiny window into the car to see the mother lying on the floor. Another woman was holding a tiny wet bundle. I could see a head move a little.

            I grabbed the driver, who I knew spoke a little English.

            “Tell her to wrap the baby in at least two more blankets! It has to stay warm!”

            “OK,” he grunted as he drove away.

            I poked my head back in the exam room window and told the MA that I was going home.

            “Eat first!” He pointed to a bench with nsima and fried fish laid out. I didn’t have an appetite. I grabbed an attendant and told her that I was very sorry to miss lunch, but I needed to go home.

            I got out to the road just in time to see the “ambulance” disappear over the crest of a hill.

            Looking down, I saw a bright green chameleon on the packed dirt. It was the first one I had seen in Malawi. I kept an identical chameleon as a pet in Uganda and name him True Love. This would be True Love 2, I decided, as I picked it up. It hissed and turned brown in self-defense, but soon calmed and sauntered up and down my arm as I walked home. I put it in a cardboard box with some grass and water. After a while, I “hunted” three grasshoppers and put them in the box, watching as True Love 2 shot out his long, elastic tongue to devour them.

            Realizing that I hadn’t yet eaten that day, I tried to start a fire. I was terribly slow, and an hour later I had only some very soggy rice. I cleaned my house a bit more, took in my laundry, and had another cold bucket bath.

            On the third morning, I wanted to show the hedgehog kids my chameleon. The girls shrieked as I brought True Love 2 out.

            “It will bite you!” the said.

            “No,” I laughed, “chameleons don’t bite. Let’s hunt grasshoppers.”

            We tromped through the field next to my house, catching grasshoppers for the chameleon’s breakfast. But though they were big and juicy, he refused to eat. I noticed that the nyerere had gotten into his box.

            “Let’s let him go.”

            The kids and I spent 15 minutes searching for the perfect spot, then we said goodbye as True Love 2 slowly walked back into the bush. We let the hedgehog go too.

            I took the kids back to my house and showed them my hand-washing station- a must for proper sanitation without running water.

            We sat in a circle and played the Chichewa version of duck-duck-goose; khuku-khuku-g’nombe (chicken- chicken- cow). We had a great time.

            Eventually I shooed them all out, realizing that I needed to cook something. I started the fire a bit faster this time, and filled a pot with water and pasta. But it still wouldn’t boil. I threw the soggy/crunchy pasta out behind my house, where some hungry dogs had been waiting for my latest failed attempt at cooking to get tossed.

            I plopped down in my very grimy living room, exhausted. I needed to scrub the whole room, but it was so hot, and I hadn’t eaten in a while, and I had no energy.

            Three of the boys from that morning were still hanging out in front of my house. I got an idea, and tried my best in Chichewa to explain-

            “You scrub, I pay 50 kwacha.”

            It took about three attempts before they understood and agreed. We went through three big bucketfuls of water, half a bottle of lavender castile soap, five sponges and a lot of dripping sweat, but finally I felt that my living room was habitable. In fact I was so happy that I gave them 100 kwatcha each. (In retrospect, probably a mistake, forever sealing my reputation in their minds as the rich American.)

            Remembering how hungry I was, I walked into town to get chippies (like homemade French fries) and a Fanta.

            I was still putting the finishing touches on my living room when the kids came back. The youngest, my four-year old neighbor, presented me with a handful of grasshoppers she had caught for me.  I think she must think that hunting grasshoppers is a hobby of mine!

            I told the kids that I wanted to start a fire.

            Together we soaked the charcoal in paraffin, just as I had done before. But again the fire wouldn’t last.

            “Put some grass on it.”

            I went out to get some grass.

            “No- this kind,” he showed me the thick reeds I had seen as thatch on people’s roofs. He broke it into pieces and shoved it into the charcoal, fanning the mixture until it was glowing red. I put a pot of water on top.

            Every few minutes as we watched the fire, they offered more advice.

            “Put more grass on.”

            “Fan it a little more”

            “Just wait.”

            And then suddenly, the water was boiling. And for the first time in Chiwamba, I had a hot bucket bath.

            I had heard from a fellow PCV that the kids are always the first to accept and teach the new azungu in town, and it’s true.  When I shooed them away that night, I told them to be sure and come back tomorrow.

In Malawi

Hi All!
Hello from the Warm Heart of Africa :-) I've been here now for about six weeks (seven?), going through PST, or pre-service training. In short, everything is going well- the team of trainees is amazing and Malawi is a beautiful and welcoming place.
We arrived in Lilongwe airport to the roaring cheers of a massive crowd of current PCV's welcoming us- another American on the tarmac asked me "Is there a celebrity on this flight?"- nope- just the Peace Corps! We were whisked off to the training center in Dedza, in the forested highlands just to the south of the capital city. There we stayed in simple dorms, getting to know everyone- Malawian trainers and American trainees. Dedza is on the side of a stunning rock face hill; a short hike brought absolutely gorgeous views of the countryside. (Pictures to come! Sorry!).
Weeks two through five we stayed with host families in rural vilages near Dedza. I have pretty much always lived alone, except during college, but suddenly in homestay I was sharing a mud house with about ten people (seven children) and 12 chickens! Thankfully the goats lived in another hut, but I suspect they used to have my room because they incessantly tried to claw their way in. Every morning brought a new heap of dirt right outside my door from the goats' tunneling efforts.
My host family taught me well- I chopped wood, made fire, cooked Nsima, rice, greens, etc...
I fetched water on my head, did my laundry by hand while trying my best to chat in Chichewa with women at the borehole, and swept out my dirt-floored room every day. My family was also enormously comforting during that very stressful time, always ready to just sit silently next to me, using the internationally understood comfort of "being there".
After five weeks we bid a big lovely farewell to our host families and villages and found out where our new homes will be. I will be staying near Lilongwe, close enough to the city for an easy daytrip but far enough away to really enjoy rural life. I visited the site last week, my first big foray "on my own", outside of the protective safety net of the Peace Corps training staff. I will be working with a Rural Community Health Centre, however, my aim is to do preventative health projects out in the villages, away from the Center. There are HSA's (Health Surveillance Assistants) who travel to every village in the catchment area to assess the water and sanitation practices, assess for malnutrition, and do basic health teaching. Over the next few months, (after swearing in), I will have lots of time to shadow these HSA's, conduct assessments of the needs in the area, fix up my house, improve my cooking skills, refine my Chichewa.....yeah there will be a lot to do.
My house is simple, with no running water or electricity, but it is also cool and spacious; I never thought I would be so excited about having cement floors! I can't wait to add all the personal touches that make a house a home. The dust of the front yard will hopefully become a kitchen garden, and the walls will be bare no more.
Today I am off to the West of Malawi for a week of language intensive, which is my last chance to really gain from language trainers' expertise. My community has made it very clear that they want me to speak Chichewa, so I am going into this week with a renewed drive to really communicate effectively.
---Then on the 26th, we all swear in and become REAL Peace Corps Volunteers!---
Last night I had a chicken salad in Lilongwe that must have been beamed down from heaven- REAL ranch dressing?! I am having waking dreams about ice cold sour cream and cheddar cheese. If you can, eat some cold dairy products and think of me :-)

Grace and Peace-
Elizabeth

The Rollercoaster

Four days and counting.
(If you are looking for contact information, open my last post)

For the first time in a week, I am feeling pretty mellow about the way-too-large pile of things sitting in my parents living room, all of which I want to take to Malawi but which of course cannot all fit. All the conflicting packing lists, the ton of shopping over the past few months, and the stress of moving all have come down to this, and I have to be at peace with it, because whether everything fits in that duffel bag or not, I'm getting on a plane on Thursday.

Last week after a wonderful visit with a friend in Boise and her new baby, I brought home the baby's cold and was in a mucousy fog for a few days. Going to the mall and walking around, looking at all the new fashions that will already be passe by the time I get back is made all the more distant, like an anthropological visit, with extra strength cold medicine on board.
When I could think straight enough again to start packing for real, I knew I was in trouble when I had hit the weight limit and only half of the things I wanted to bring were crammed in my bags. "Be Brutal" has been my mantra lately. Be Brutal with giving things away, don't hold onto things you don't need. It seems my brutality toward my things needs to be cranked up several more notches.
What if I can't fit my yarn and can't buy it there? Will I go crazy from not knitting? How can I survive with only one (insert object here) when I have ten of them that I love so much?? I noticed that all of these thoughts were about ME. And I remembered that, while I need some objects of comfort in Malawi, it really isn't about comforting ME. That isn't why I applied to the Peace Corps. For as much as I aspire to not be defined by my STUFF, my baubles, this is a chance to actually make it happen. So it isn't a sacrifice as much as a challenge.
So then when I was pondering this I tripped and spilled out all the contents of my purse and just burst into tears. Real, snotty gross tears. And it was ok. I had to go to a dinner party, and showed up still crying and no one cared. There was a champagne toast to my new adventure, and lots of laughter and prayer and showing pictures, and I knew that I could be myself, on this rollercoaster of emotion, and still be normal.
A few days ago, I was reading in our facebook group for the Malawi team, and one of the current PCV's in Malawi wrote a really touching note that said though it is sad for us to leave home, we are not just leaving a family here, we are gaining a big, crazy, lovely family in Malawi, who are preparing today for our arrival and will welcome us with lots of hugs, and who probably wont care if I start crying again (which I probably will at some point). So I am going from loving family to loving family, and just taking whatever will fit in that duffel bag with me, and I am ok with that today. :-)


Grace and Peace,
Elizabeth

Contact Information

On February 24th I will be flying to Philadelphia for some initial orientation, and then early on the 26th comes the long flight from New York to Johannesburg, and then a quick hop to Lilongwe, Malawi, arriving on the 27th.

Training in Malawi will last about nine weeks and consist of language learning and technical skills. I will be staying with a Malawian host family for most of that time. In late April I plan to swear in as an official Peace Corps Volunteer (until then I will be a "Trainee") At that point I will move out to my site, where I will be spending two years.

During training I will have no access to e-mail or internet, so I would really appreciate any snail mail, even just a quick letter :-)

My address is:

Elizabeth Karman, PCT

Peace Corps

PO Box 208

Lilongwe, Malawi

Africa

AIR MAIL

Letters currently cost $.98 to mail from the US. 

This PO box is for the Peace Corps main offices, and I will be able to pick up mail there when I am in Lilongwe. After I move out to my site I may get my own PO box that is closer, but mail sent to the above address will still get to me. I will update this if and when I have a new, closer address. 

Here is what the Peace Corps says regarding mail:

---Mail takes a minimum of two to three weeks to arrive, often longer. The Peace Corps advises friends and family to number their letters (so I will know if any are missing or out of order), and include "Air Mail" and "Par Avion" on their envelopes. Packages take six to nine weeks for airmail, and surface mail packages take around six months. If someone is sending you a package, it's advisable to keep it small and use a padded envelope so it will be treated as a letter.---

I went to the post office to price postage- padded envelopes are also much cheaper than boxes to mail! Currently a flat rate international large envelope is $13.95.

Some other Peace Corps web sites and books recommend writing the address in Red ink, and also writing religious symbols or scriptures on the package. 

After I have been in Malawi for six months, I will have to start paying duty on packages valued over $20, which I have heard is very expensive and would eat up most of my salary- so when filling out customs forms, keep this in mind. I would love any package- it's the thought that counts, right?

Many friends have also asked how they can pray during this time- please pray for a safe journey, ease of language learning, and protection from disease, especially stomach problems. Thank you!

Grace and Peace-

Elizabeth Karman

Goodbye Job!

So yesterday was my last night shift before moving to Malawi. I've worked on the same unit in some capacity (aide, nurse tech, RN) for about ten years, so moving on was not an easy decision. It's not just the change in location though. My work in the Peace Corps will be very different than bedside nursing, and despite the many crazy shifts where I swore that I hated bedside nursing, the truth is I know that at some point I will miss it. I will miss writing my name on the wall and telling someone "I'm your nurse". Nurses get to see so many sides of humanity that are hidden from much of the world. They become interwoven in grief, anger, and loss, and are included in the celebrations of small victories. I had never been exposed to so much fear, love, regret, obscenity, hatred, sacrifice, danger, callousness, paranoia, helplessness, and hope as I have here. Now one adventure has ended, and thankfully, it has propelled me to the coming adventure overseas.

Some things that I learned on the floor:

-what a pannus is (and a Fumpus- thanks Amy!)
-to dilute ativan before trying to run it through a 22g IV on a hard stick
-to NOT tell patients that TPA is "like drano" for your line. People think literally.
-to never get between a brain tumor patient and a stairway
-that addressographs wont break the windows but chairs will
-that most people don't realize that oxygen is flammable, and still don't believe it when you tell them
-how to say "I'm your nurse" in Georgian, "I dont speak Russian" in Russian, do a full assessment in Spanish, and how to say thank you in six other languages
-that when you say "I don't speak Russian" in Russian, most people assume it is meant as a joke and continue speaking in Russian...
-to always wear a mask when aggressively unplugging a PEG tube
- that warm blankets are like a crude form of hospital currency
-to wear my hair up and back when doing extensive dressing changes (learned REAL FAST!)
- that nurses running in the halls is always a bad thing
-that patients running in the halls means that its time for them to go home
-that no matter what my ACLS teacher said, compressions alone CAN pop someone out of asystole
-that it is possible to lose two gallon tubs of liquid stool between my floor and the lab
-that nurses are as diverse a group of people as everyone else, and we aren't angels
-that CF sucks and needs to be cured asap
- that running backwards pulling a bed going to the unit is an awesome glute workout

more to come when I think of them. Love to all my co-workers/ friends.....and a thousand big bear hugs to the MoTard :-)


Grace and Peace-
Elizabeth

-
-
-

Christmas break from packing

So it's less than two months now before the Malawi staging. I know that I was really lucky to get my invite so early, but that's also making this time of waiting seem to drag on and on. Someone at work asked if I was afraid to leave, and I said no.
"Afraid of anything??".
 "No, if I could I would leave next week."
"That's not normal.......".
Yeah, maybe its not, and I'm sure some fears will wriggle their ugly little heads out in the coming months, but I plan to swat them down like flies. And maybe cry a little. But then get back up and on my way.
This Christmas was wonderful. Very damp and dark outside- perfect for remembering Seattle. I got everything I asked for- right down the gardening gloves and the new Bible with my name one it (spelled correctly- WOW!) I asked for some odd things and my parents are troopers for cooperating ;-)
Still left to get:
Solar charger
hammock

Still left to get rid of:
three rooms chock full of stuff I suddenly don't need (or did I ever really need?)

Lessons Learned this month:
Furniture is surprisingly hard to give away
I am going to miss bedside nursing like crazy, even though I know it's time to move on
My cat has impaired depth perception

Merry Christmas!

Grace and Peace-
Elizabeth