Malawi: Dr. Michelle Kiser

General Surgery resident Michelle Kiser is in Lilongwe for six months, June through December 2011, with her husband and two young daughters. Follow their experience at Dr. Kiser's blog: kiser-yenda. Here are some of her entries:

April 6, 2012: Yesterday, Bingu Wa Mutherika, the president of Malawi, died at our hospital in Lilongwe. He suffered a heart attack and, despite CPR and resuscitation for over an hour he was reported to have died at 1pm. He was 78 years old. It was quite chaotic at the hospital, as his motor caravan was parked outside of the casualty department all afternoon. None of us, of course, were allowed into the ICU. But we were able to get reports coming out. Everyone knew something was going on with the president, but even as of today many forms of the media available to the majority of Malawians (newspaper and radio) are still saying that he is in critical condition in South Africa (where they flew his body last night). The current executive government officials are not disclosing the confirmation or details of his death, though everyone at the hospital knows that he has died, and bigger, reputable, online news sources have all confirmed his death (nyasa times, Malawi democrat, and I think finally the BBC).
There is an interesting political twist, in that the constitution states that the Vice President, Joyce Banda, should now become president. BUT, she was kicked out of the current ruling Democratic Progressive Party (DPP) in 2010, and has openly opposed the president and his party--creating her own political party. So, naturally, everyone is wondering if the current executive officials will try to stop Banda from becoming president, and go against the constitution. Already, professors of law down in Blantyre, and the previous president, Bakili Muluzi, have spoken out saying that officials in the DPP have NO right to stand in the way of Joyce Banda becoming president. So we shall see.....

October 16, 2011: "Yesterday, October 15th, was Mother's Day in Malawi. Therefore it is a 3 day weekend! I spent mother's day doing what mothers do best--tending to my sick children. We have been ravaged by some illness that causes high fevers and body aches (and it doesn't seem to be malaria). I have come through it, and am hoping both children will soon enough. Yesterday was also the International Day of Rural Women, and there was a nice article in the national newspaper, The Nation, interviewing Joyce Banda, Malawi's current vice president and influential leader. The article stressed the importance of rural women here, as the backbone of the family and community. They are the mainstay of all the agricultural labor, responsible for the backbreaking work of tending the fields. They predominantly care for the family, sick members of community, and orphan care. And Joyce Banda, who has been responsible for several large government and private service initiatives, mentions that women have historically been critical in programs designed to eradicate hunger and poverty, AIDS awareness, etc. I am repeatedly impressed by the physical and emotional strength of the women here. I see them all the time carrying large loads on their heads, small children on their backs. They walk for miles and miles this way. The vast majority of Malawian women, on a daily basis, go out, cut down and hack up trees for firewood with machetes, pile it up and carry it home on their heads, then prepare the meals over the fires. And all after doing the majority of the agricultural work. And usually with multiple children on their backs and by their sides. This is no exaggeration. I have only captured two shots on my camera, but have seen a hundred more that are equally as beautiful.

September 24, 2011: "Patient guardians here are amazing - I am hoping to do a study, interviewing them, to find out more how they cope with the experience of caring for their loved ones with such severe burns. They have to search for ingredients to buy for food, prepare meals, feed the patients, hold them while their dressings are changed, sleep on the floor beside the beds, comfort and support them - and they do this for the weeks and weeks that the patient is in the hospital. They can never leave. All patients must have a guardian. Sometimes mothers and fathers will switch out, or an aunt will come..."

William Kalua, a clinical officer in the burn unit, improvising one day in the operating theater when we had no facemasks. The image on the right features him with pieces of tape, stuck to his face.

August 5, 2011: "I took call at the hospital Wednesday for the first time since I have been here. It was an experience. I got called to come see a patient in the women's hospital, and as I walked through the hospital, which is all open air - outdoor walkways, window openings in all the hallways, nothing enclosed - I realized what a different place the hospital is at night. There are no lights in the corridors. It was so dimly lit that I was worried I might stumble over anything that was in my path. I would hardly know I was passing someone until I would hear "Good evening, Madam". Yet you know that there are probably around a thousand people hunkered down for the night in the wards. The guardians come in at night and sleep on the floor under the patient's bed. So as I went to examine this woman with abdominal pains, I had to tiptoe around the sleeping, nursing guardians. But it felt oddly cozy in the wards. They are all so quiet."

The Burn Power Team

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June 30, 2011: "I began operating this week. It is very different from the U.S.. It will take me a few days to figure out everything works. And everyone in the OR speaks to each other in chichewa! But people are generally helpful. I am really just observing how the burn operations are done right now--getting a feel for what they do. It barely resembles what we do at UNC. Our oldest patient is 6 years old. Children are by far the majority of the burn victims, and it is almost exclusively due to open fire cooking in the home. The nurses work hard with so very very little. They rely on parents to help with dressing changes too, as they have little help, and they state that it is very hard on parents, who sometimes are even scared to touch their burned child."

June 23, 2011: "Went to the hospital today for the first time. It was pretty overwhelming. It is amazing to see people waiting everywhere for care--on the ground, in crowded hallways, on the road near the hospital. Patients' families all spend their days out on the grassy lawns, and at night sleep in the hallways to be there to care for their loved ones. And everyone is patient. No one loses their cool. No one is demanding. They just wait. The burn unit is a newly converted ward that used to be labor and delivery until the Bill Clinton foundation built a new women's hospital next door. Most patients are pediatric. I am very excited to be working there."