Since March, I’ve been volunteering at Baylor’s clinic, the Center of Excellence (COE), next door to a massive public hospital, Kamuzu Central Hospital. I was lucky to get this posting through Jon’s great colleagues at Baylor and I’m so glad to have this opportunity. (You may recall I had a really difficult time finding volunteer opportunities in South Africa…)
I go to the clinic four days a week, all day, and work in the triage department. This clinic is operated by Baylor staff and is, primarily, a pediatric clinic, focusing on HIV. The patients have regularly-scheduled appointments based on how they are doing on their treatments and they can also come in if they are sick. (That’s why I do not come on Fridays – only sick patients are seen that day and they come in pretty sporadically…) The patients check in using their health books (it’s like a patient essentially carrying his/her health records with them everywhere) and their chart is pulled by the front desk staff. Then, staff from the two triage rooms come and collect the charts, call the patients and the patient goes back for evaluation. Most of the time, the kids come with a parent, a guardian, etc. but sometimes they come alone. (Especially the older kids.) It’s been quite an interesting experience to be the one to call the names because, try as I might, my pronunciation is never good enough. (One of my colleagues, Christina, sometimes helps me with a name I’ve called a few times – with no success – and then they come the second she says their name. ‘Pongono, pongono’ – ‘little by little.’) 🙂
When the patient comes to our room, we record their weight, height and MUAC (mid-upper arm circumference) in their health book. Based on their MUAC and age, we determine their nutrition level – normal nutrition, mild malnutrition, moderate malnutrition or severe malnutrition status. (For anything but normal, they talk to the nutrition counselors.) Then, if they are on antiretroviral therapy (ART), we count how many pills they have on hand since their last appointment. This is to assess their adherence and the electronic health record calculates this based on how long it has been since they were in the clinic, how many pills they take per day, how many pills they were given by the pharmacy last time and how many they have left. If their adherence is under 95% or over 105%, they are referred to the psycho-social counseling team to work on improving their medication intake. Then, we ask how they’re feeling and if they don’t have any concerns, they will see one of the nurses. If they aren’t feeling well, they’ll see one of the clinicians. (There is also a phlebotomy room for the patients who complain of symptoms like fever, abdominal pains, headache, etc., which are common symptoms of malaria. They then get their blood tested to see if they’ve been infected.) Patients also come to the clinic that are on TB treatment (which is scarily common in people with HIV) and there are also some patients seen who have cancer. The adults who come to the clinic are patients that were seen as children there and have ‘aged out’ of pediatrics. They have their blood pressure and heart rate assessed at their visit.
The above outlines what I do on a typical day but we have a couple of special clinics, as well. We see teenage patients who are pregnant or who have just had a baby, on a dedicated clinic day, once a month. They are evaluated to make sure that they are progressing well in their pregnancy or to make sure their baby is healthy and, overall, coach the prospective mothers on how to minimize the chances of passing along HIV to their unborn child. (There is a whole process for determining if the baby has HIV as it grows, as well.) We also hold ‘Teen Club’ once a month, which is a special clinic on a Saturday where kids of a certain age group come to have their evaluations and then an activity is held for them afterwards, focusing on education, life skills, etc. It is quite a day because we start at 8:00 am and see hundreds of kids! (It’s better for them on the weekend because school can create quite a conflict for them during the week.) My first Teen Club was quite a crazy, deer-in-headlights day for me! Teens, everywhere! But, it’s quite an amazing thing. Especially since the whole clinic comes in to work and help.
I’ve really learned a lot in my time at the COE so far. First of all, the staff has been great with teaching me Chichewa, the language spoken here. I’ve learned most of the common medical terms and can even understand when they start speaking in full sentences, sometimes! (Though, usually, I need a lot of help…) I’ve also learned a lot about my awesome colleagues – they’re hard-working, lovely people who enjoy and depend on their work (and enjoy each other’s company). I’ve had some very unique experiences so far, including:
- There was a boy in our room one day who kept his pills in vitamin C bottles at boarding school so his friends wouldn’t know he’s on HIV medication. It broke my heart.
- A four-year-old patient at the clinic said to me (in Chichewa), “Hey! Mzungu! [White person!] Where are you from?” I responded – his dad translated for him – and he said, “Hey! I don’t fear you!” I told him he shouldn’t and he thought about it and then said, “I like chocolate!” It was the best conversation I’ve had here. 🙂
- A woman in the clinic asked if I’m happy under Trump – as she assumed I’m from the U.S. – and when I said no, she seemed very confused. She told me that he’s a good, god-fearing man. I told her that I’m not sure, with quite a bit of discomfort. (And then I obfuscated and said I hope he does well, so I could stop talking to her and not offend her.)
- I’ve been, essentially, adopted by one of the long-time nurses there, Rose, and it’s been so nice. I’m in her triage room every day and she invites me to have a cup of tea with her during clinic, without fail. We’ve talked about our families, what’s going on in Malawi, and many other topics. It’s really made me feel like a part of the team there! (Also, she prepared nsima flour for me, after I told her that I loved it and wanted to learn how to make it at home. It’s no easy feat to prepare the flour so I was very touched by her doing that for me!)
- After our trips to Italy, etc. and to Amsterdam, etc., I had the warmest welcomes when I returned to the clinic! Multiple people told me they had missed me, were wondering where I was, etc. It was really nice! (And, a few people told me I’d gotten fat, which, apparently is a really good, positive compliment here. Erm… Too much pasta and cheese, I guess?!) 😉
As I’ve talked about before, my goal when we return to the U.S. is to apply to Physician Assistant programs and my time at the COE is helping me with one of my pre-requisites for my application. But, I’m also learning valuable things about life, as cheesy as that sounds. I’m learning about practicing medicine in another country, what Malawians go through on a day-to-day basis, the things patients have to do to get to the clinic and receive their care, how warm Malawians are (which I’d heard about but hadn’t experienced so first-hand before in the ‘Warm Heart of Africa’) and much more. It’ll never not be difficult to see a six-month-old baby with HIV. It’ll never not make me sad to see a parent (who is sick, themselves) bring their child in to be checked out when they have malaria, sometimes cancer and HIV. But, I feel heartened to know that great people from the U.S. and, more importantly, from Malawi are taking care of them and trying to continue Baylor’s vision of providing a ‘healthy and fulfilled life for every HIV infected or affected child and their family.’ And I know that the COE will make me a better PA and a better person. ❤