By Daniel Dyer, M.D.

8/12/19

Life in Malawi has been a microcosm of heartbreak and triumph. Almost every day has moments that leave me scratching my head, wanting to cry, smiling and wanting to scream in frustration.

For example, the child I mentioned in my last post with bronchiolitis. The patient was weaned off of CPAP but continued to need O2. After several days, the mother started demanding to leave. Her initial reason was that she had another sick child, however it also turned out that she was polygamous relationship and was worried about losing the attention/favor of her husband. We discussed the child with her for a long time. She was discouraged that the child didn’t seem to be getting better and when told that the child could worsen and die if she went home, stated that she understood and what would happen would happen. When I came by the room again later, the patient and her mom were gone. So much for my example of hope, but perhaps an important lesson. Life here is complex, as is the provision of aid. Behind every story is a weight of culture, family, untold (or untranslated) story and even the long shadow of imperialism. When I attempt to reduce all of this down to a nice story to illustrate a point I inevitably obscure some of that complexity. The story might miss the weight of a bill for a hospital stay on a family already uncertain where to find means for food and school. It misses the social complexity of a prolonged hospital stay and required absence one of the parents of frequently large families. Often it underestimates the burden and stigma of a new chronic disease diagnosis. We know in part...

This morning I helped stabilize and transfer a patient to the large central hospital. It’s difficult to describe what it’s like to bag a patient on a seat in the back of an ambulance in Africa as you fly down a crowded road at 140km/hr. The 2yo boy had come in vomiting (or coughing?) up blood with significant jaundice and was found to be unresponsive by the night team. When I walked into the ward in the morning they were in the process of resuscitation. We were able to get the patient intubated and stabilized but didn’t have a ventilator, so I used the bag for a couple hours while we worked on further diagnostics and trying to find an ICU bed for the patient. Thankfully there was one available. It was a whole new experience trying to organize a transport to another facility. In the US the transfer teams are very competent, have extensive equipment and are experienced with troubleshooting and stabilizing . In Malawi it is you. So after coming up with all the medications we might need and the ability to maintain the airway, we made the transfer to the backseat of the ambulance. The ride was harrowing. Siren blaring (which mostly didn’t phase anyone) we zoomed around corners and in between cars. Driving in Malawi is an adventure at the best of times. This was something else. But we made good time and soon we were pulling into the central hospital. Amazingly, a PICU doctor from the US met us in the stabilization room. She had just arrived two days before. There was one last ICU bed available that our patient took. As we were driving, I was praying for the patient as there were times when things appeared to be heading down hill. Modern medicine has done so much and made significant improvements in our ability to treat illness, but I’m becoming convinced that sometimes we still need a push in the right direction. I believe God was watching over this child and using us and others to meet some of those needs.

Working with sick children here in Malawi can be draining and discouraging. Death always seems to be near. But so also are family and friends (almost every child has a guardian in addition to their mother, often a relative or neighbor who helps to take care of the patient in the hospital). And so also is God.

Daniel Dyer, M.D.

8/12/19