I landed at Kamuzu International Airport in Lilongwe, Malawi, on Friday 25 May around 12h30. You don't need to apply for a visa before going to Malawi, you stand in the line after arriving and when you get to the front, the official asks you how long you'll be staying in Malawi and gives you a visa for that length of time.
I was happy to a see a luggage carousel on the other side and found my bag quickly. I was hoping that I wouldn't be stopped for a bag search as I had some smoked rainbow trout in my bag for Anna, and I wasn't quite sure about the legalities of importing fish into Malawi! Just before the exit some officials stand and randomly choose bags to search, I was briefly questioned and told to continue. I was outside the airport before Anna arrived to pick me up. It was a warm day, and since the three flights that land at Kamuzu International everyday land within minutes of each other, there was a bit of a bustle outside and I was approached by lots of cab drivers looking for business.
(My passage through Kamuzu International on my return journey was a little more eventful, not only did I have to unpack my bag for a security check, I also had to somehow figure out when my plane was boarding without information screens or official announcements! An interesting end to the adventure.)
I easily spotted Anna driving in a huge Land Cruiser, her white blonde hair and signature bright blue top were like a beacon. First we headed to her house (10/393 Lilongwe) and off loaded my bags with the help of the gardener and house keeper (who both rushed to the vehicle to greet us and carried my bags off to the room I would be staying in) before a small lunch and then heading off to see Kamuzu Central Hospital, which is the main hospital in Malawi's capital city. This is the hospital the late President Bingu wa Mutharika was taken to on 5 April 2012 when he died.
Visiting the hospital made me appreciate practicing medicine in South Africa, which is not devoid of challenges, but the challenges we face on a day to day basis in South Africa pale in comparison to the rest of Africa. My interest in the hospital tended toward the practice of anaesthetia and I could not believe how old the anaesthetic machines were in the obstetric theatre- one even had an ether vapouriser mounted. The fact that shocked me most, was that endotracheal tubes are washed, soaked in a disinfectant and reused! Also, there are no filters between the patient and the breathing circuit and in some theatres they have to ventilate a patient by hand for the duration of the procedure!
Theatre and the obstetric unit were the best areas of the hospital. We went to see the paediatric wards after that, it went on and on. They apparently admit an average of 80 patients per day and only have two doctors. The adult general wards were sad. Patients were lying on mattresses on the floor outside, some lying in their own excrement.
Keeping with the medical theme, on Saturday evening I had the privilege of meeting Professor Staffan Bergstrom of Karolinska University. As Anna put it, he is something of a celebrity in the field of obstetrics in low resource settings, and he was in Lilongwe for 24 hours. He came over for dinner on Saturday evening- a most fascinating man to meet and speak to.
Professor Bergstrom became interested in the anti-apartheid movement in the 1970s and moved to Mozambique in 1982. Mozambique was at war with the apartheid government of South Africa at the time and the professor became involved in an effort to train non-physician surgeons in Mozambique. Because of all the war casualties, many "surgeons" were practicing illegally in remote areas of Mozambique, without having had any formal surgical training. The authorities decided to train them and use them as part of the formal medical work force, which was so inadequate to meet the needs at the time.
This was the start of a revolutionary move in African countries, to train non-physicians to perform emergency surgery, particularly emergency obstetric surgery.
After retiring back to Sweden many years later, the professor was persuaded to come back to Africa, and now works for the Bloomberg Foundation in Tanzania, training non-physicians and midwives to perform emergency caesarean sections. The midwives administer the anaesthetic (spinal anaesthesia) and the clinical officers perform the caesar.
Professor Bergstrom told me that he is not a rich man, but he's had a very rich life. In Dar Es Salaam he lives with his wife, in the same kind of area that the average Tanzian would live in, and it was the same in Mozambique.
As a doctor, and as a human being, he is quite an inspiration!
On Sunday morning, Anna and I went cycling around Lilongwe with Iain, a friend of Anna's.
Lilongwe felt to me like a rural South African town, but significantly cleaner. Within minutes we were out among maize fields and cycling through villages. In one village we came upon the above young butcher. It was quite a spectacle for us to watch him skinning a goat so skillfully. The three of us on our bikes were quite a spectacle to everyone else around: we were watching the butcher, everyone else was watching us watching the butcher!
We became even more of a spectacle a little further down the road when Iain had a puncture. We happened to be near the mechanic's place and were told to consult him. Everyone stopped to give advice or just gawk. I only managed to get this picture when there was a little lull in the crowd, usually I couldn't see Iain or Anna for the crowd! And even when we didn't actually stop in the villages, there was usually a group of children running along shouting "mazungu!" when they saw us, which is the equivalent of "mlungu" in Chichewa - white people!
We cycled on to Kumbali village for breakfast under the trees, with a live band: The Jirere Band. Near to Kumbali village is Kumbali Lodge, where Madonna usually stays when she visits Malawi. Apparently you have to make a booking even if you just want to have coffee at the Lodge's restaurant, so we didn't bother popping in.
Being full from a huge breakfast, we decided to take the shortest route home, which was also a good idea since the sun was quite high and hot by that time. Luckily I had remembered to take my sunscreen along with me, even though it had been quite cool when we started out, or I would've been a tender bright tomato by the next day.
We had a late lunch at the Four Season's garden cafe and stayed on for the regular Sunday evening jazz. It seemed to me most of Lilongwe's coolest were on the lawn that evening, and I enjoyed an MGT (Malawian gin & tonic) and a bit of people watching. After jazz it was back to 10/393 Lilongwe, to pack for Zambia and get ready for an early start the next morning.
I was happy to a see a luggage carousel on the other side and found my bag quickly. I was hoping that I wouldn't be stopped for a bag search as I had some smoked rainbow trout in my bag for Anna, and I wasn't quite sure about the legalities of importing fish into Malawi! Just before the exit some officials stand and randomly choose bags to search, I was briefly questioned and told to continue. I was outside the airport before Anna arrived to pick me up. It was a warm day, and since the three flights that land at Kamuzu International everyday land within minutes of each other, there was a bit of a bustle outside and I was approached by lots of cab drivers looking for business.
I easily spotted Anna driving in a huge Land Cruiser, her white blonde hair and signature bright blue top were like a beacon. First we headed to her house (10/393 Lilongwe) and off loaded my bags with the help of the gardener and house keeper (who both rushed to the vehicle to greet us and carried my bags off to the room I would be staying in) before a small lunch and then heading off to see Kamuzu Central Hospital, which is the main hospital in Malawi's capital city. This is the hospital the late President Bingu wa Mutharika was taken to on 5 April 2012 when he died.
Visiting the hospital made me appreciate practicing medicine in South Africa, which is not devoid of challenges, but the challenges we face on a day to day basis in South Africa pale in comparison to the rest of Africa. My interest in the hospital tended toward the practice of anaesthetia and I could not believe how old the anaesthetic machines were in the obstetric theatre- one even had an ether vapouriser mounted. The fact that shocked me most, was that endotracheal tubes are washed, soaked in a disinfectant and reused! Also, there are no filters between the patient and the breathing circuit and in some theatres they have to ventilate a patient by hand for the duration of the procedure!
Theatre and the obstetric unit were the best areas of the hospital. We went to see the paediatric wards after that, it went on and on. They apparently admit an average of 80 patients per day and only have two doctors. The adult general wards were sad. Patients were lying on mattresses on the floor outside, some lying in their own excrement.
Keeping with the medical theme, on Saturday evening I had the privilege of meeting Professor Staffan Bergstrom of Karolinska University. As Anna put it, he is something of a celebrity in the field of obstetrics in low resource settings, and he was in Lilongwe for 24 hours. He came over for dinner on Saturday evening- a most fascinating man to meet and speak to.
Professor Bergstrom became interested in the anti-apartheid movement in the 1970s and moved to Mozambique in 1982. Mozambique was at war with the apartheid government of South Africa at the time and the professor became involved in an effort to train non-physician surgeons in Mozambique. Because of all the war casualties, many "surgeons" were practicing illegally in remote areas of Mozambique, without having had any formal surgical training. The authorities decided to train them and use them as part of the formal medical work force, which was so inadequate to meet the needs at the time.
This was the start of a revolutionary move in African countries, to train non-physicians to perform emergency surgery, particularly emergency obstetric surgery.
After retiring back to Sweden many years later, the professor was persuaded to come back to Africa, and now works for the Bloomberg Foundation in Tanzania, training non-physicians and midwives to perform emergency caesarean sections. The midwives administer the anaesthetic (spinal anaesthesia) and the clinical officers perform the caesar.
Professor Bergstrom told me that he is not a rich man, but he's had a very rich life. In Dar Es Salaam he lives with his wife, in the same kind of area that the average Tanzian would live in, and it was the same in Mozambique.
As a doctor, and as a human being, he is quite an inspiration!
On Sunday morning, Anna and I went cycling around Lilongwe with Iain, a friend of Anna's.
Lilongwe felt to me like a rural South African town, but significantly cleaner. Within minutes we were out among maize fields and cycling through villages. In one village we came upon the above young butcher. It was quite a spectacle for us to watch him skinning a goat so skillfully. The three of us on our bikes were quite a spectacle to everyone else around: we were watching the butcher, everyone else was watching us watching the butcher!
We became even more of a spectacle a little further down the road when Iain had a puncture. We happened to be near the mechanic's place and were told to consult him. Everyone stopped to give advice or just gawk. I only managed to get this picture when there was a little lull in the crowd, usually I couldn't see Iain or Anna for the crowd! And even when we didn't actually stop in the villages, there was usually a group of children running along shouting "mazungu!" when they saw us, which is the equivalent of "mlungu" in Chichewa - white people!
We cycled on to Kumbali village for breakfast under the trees, with a live band: The Jirere Band. Near to Kumbali village is Kumbali Lodge, where Madonna usually stays when she visits Malawi. Apparently you have to make a booking even if you just want to have coffee at the Lodge's restaurant, so we didn't bother popping in.
Being full from a huge breakfast, we decided to take the shortest route home, which was also a good idea since the sun was quite high and hot by that time. Luckily I had remembered to take my sunscreen along with me, even though it had been quite cool when we started out, or I would've been a tender bright tomato by the next day.
We had a late lunch at the Four Season's garden cafe and stayed on for the regular Sunday evening jazz. It seemed to me most of Lilongwe's coolest were on the lawn that evening, and I enjoyed an MGT (Malawian gin & tonic) and a bit of people watching. After jazz it was back to 10/393 Lilongwe, to pack for Zambia and get ready for an early start the next morning.
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