Returning home

Leaving the guys down in the south as they were to carry on to Blantyre and I was to return home as my three weeks annual leave was up, I felt sad. Peter made it better when he said how great I had been as audiologist and a team member connecting with everyone on the trip.

Before leaving for the airport I stayed one more night with the bartletts and Mwasoni came round in the morning with a painting he had made me, an ABC shirt and a bracelet he made me with my name on it, it was such a lovely thing for him to do . I also met his beautiful  son Raphael. Mwasoni - star :)

On my flight travels home my thoughts were filled with what a brilliant trip and experience I had had and that I had finally done something like this. They say with such things you try it and love it or you find it too hard. Well I loved it, audiology in developing countries is something I will be doing again, and is something more audiologists should do. I have learnt this is something I really feel I can help , that I  manage travelling alone fine , intergrating with new team members well . I do need to work on my sign language and although audiologists arent trained to remove wax in the UK, that I will find a course to do so because it is a big barrier in areas where a Dr is not present to perform what we need to do.

Malawi - the warm heart of Africa

 http://www.youtube.com/watch?v=rgL_YEqoAn8 I put together a little video - if you liked my blog have a look.  :- ) x

Back at the ABC

The next week was a little different, we had the "south team" ABC students to join us now and it was back to the safari lodge at lilongwe. With the first night there quite noisy and cramped we were hoping it to be a little bit of an easier stay this time.
So Day 16 it was off to the ABC to meet up with the south team and for children from an orphanage in Lilongwe to be bused over to us for testing. We took over the whole maternity wing for this. Only 12 children were send over, it felt not the most productive day ... which was easy to say in comparison to the following day where we headed off to a nearby secondary school where anyone could attend.

Day 17 at the secondary school near 500 children and adults came through the door ( advertisement /posters were made by the south team days before which helped) we were extremely busy. 200 of them got to the ear cleaning stage but did not go further due to either a bad infection or that the OAE screen passed.

After an exhausting day, it was rewarding to know that we had found those who needed treatment for infections or needing hearing aids to be fitted at the ABC.For peter and rebbecca doing such a job alone would take a long time so having so many us of ment in this field we had been a big help. :)


My last few days were spent down in liwonde national park...safari.....you guessed it...

Salima

Day 14 - adventure to get to salima started. We left Embangweni and once again said goodbye to the children at the school and collected our equipment.  We set off after breakfast in our bus with trailer just going through embangweni the connection to the trailer broke. so frieghton our bus driver managed to get someone in the town to weld it after half an hour we set off again and it broke once again this time along the road in the middle of no where. We all had to get out and wait with the trailer while the bus went back to town to get it ptoperly fixed.

3 hours went by at the side of the road, many cars slowed down just to see the 'musungo' sat at the side of the road. We passed the time with music, stories and playing cards. The bus finally game back all fixed and ready to go.

We dropped half our team, all the ABC students off at kasungo where they were to get a bus to lilongwe. It was a sad time. When we got back on the bus it felt empty just peter myself and the US team.

 We were 5 hours late on out schedule to salima. which did cause a problem as we needed to go through a game reserve to get to salima at it closed at 6pm. It was now 6.30. the man at the entrance said we could not  pass due to it being night time, Peter and freighton discussed with him and the man said we could pass for extra money 'bribary' . we passed through and by 9.30 we arrived at salima, night time but still looked beatuiful and alot different to the previous accomdation we stayed in. day 15 awoke to waves crashing and a lovely included buffet breakfast ....perfect, time for a swim in the pool.

Embanweni School for the deaf

Day 8 to 13 was to be spent in Embangweni which is a mission station in Livingstonia. Quite of the beaten track no roads, more a track to get there and the roads very bendy. Frighton did a very good job getting us there safely. On our way there we started to teach each other songs. Peter wanted to have a go with one of his favourite U2 - Still havent found what im looking for (still stuck in my head)

The headteacher welcomed us on our arrival and we headed to where we would stay for the next few nights. sharing with my Shar again was great, such fun company. It was Alinanes birthday, which she kept very quiet about . Myself and Shar felt we should do something so we made a card and brought it round for everyone to write a personal message on and we were to present it at dinner time. At dinner time after we had had our yummy rice and beans we presented it and alinane was shocked and happy, it was a lovely experience, alinane works so hard to she her smile at our card was lovely. 

Our challenge for the week at Embangweni was to test all 180 children (who have currently 10 teachers) , fit those who need to be fitted and train the teachers in appropriate audio topics.  As this time we had everyone at the school (bar peter and occasionally ingrid and courtney going to the hospital for ear care) rather than half at school half at hospital in karonga. Each morning we had devotions where the whole school would get together at 7.30AM. It interesting to see and a privage to be a part of, there we hymns, talks and bell ringing (by colour due to deafness, children rang there colour when stated on the sheet in turn) 

More planning was needed especially with more children to cover. We initially set up  one room for wax removal/ otoscopy and tymps another room for 3 audio testing stations and a room for fitting HAs. After the first day finding this got hectic and hold ups appeared at stations it was organised better the next day at an evening discussion over dinner and it was all based in one room. It was good to debrief at the end of the day to help make the next day better. The second day I got to work with Courtney and fix up the child with hearing aids I really enjoyed this as hadnt got a chance to do this yet.

This was our fitting room very chaotic and when running low on supplies we were doing multiple at a time. I made near 60 impressions that day. The plan was each child would have a temporary mould made so the HA could be fitted straight away ( this was new to me learning to make , pour hole in, trim and attach temp moulds) and permanent moulds that would be taken back to the US and then sent back to them (each childs mould was bagged and named) . This was my favourite day in embangweni because you could see the benefits of the children once they were fitted. the ABC students were great in assisting and helping councelling the children. 

patricia counselling one of the students

Testing the children continued through to day 11.  The day 12 we had alot to plan for we had fitted 70 HAs altogether which was great but we needed to make sure they would be maintained and looked after otherwise it would be like a "HA dump (hearing aids just programmed up with little info and no follow up) which we were vastly trying to avoid.

The plan 

• that each dorm mother for each dorm of children would have a box with whos HAs need to be kept in there at night. 
• Each teacher would have a list to who should have their HA in 
• Training sessions to be given in ear care- observing infections as a number of children had foreign bodies and cotton wool deep in their ear canal ( so training to avoid this) 
• Training session in HA care for teachers and dorm mothers. 

refreshing the headteacher of the school on BSL ( they use more ASL and malawi signs.) while making teachers listening devices to check the HAs( will be sent out with the permanent moulds)

By the end of day12 we had tested all 180 children, some parents and a family who had travelled from zambia. Fitted 70 hearing aids, councelled and have 70 perrmanent moulds to be sent back to the US. Trainning to staff at the school and fingers crossed for contiuned care. Peter said they will visit embangweni but wont be able to do so as much as karonga. 

  Hearing aidsssss! :) 

Mayoka Village -nkhata bay

On the eve of leaving Karonga we had a leaving meal with the teachers and two representatives from the australian mining company. The picture above shows our first touch experience of lake malawi. We had dinner right next to it, I still wonder what the view would have been like at day time. This was the beginning to our lake adventure.

We headed to our next stop which was to be "our day to relax by the lake" took about 4 hours to get there.
I kept thinking to swim or not to swim, I brought no swimming costume to make sure I didnt, however our first proper glimpse of the lake was absolutely beautiful.  Mayoka Village was run by a brittish lady and south african partner. It had a british feel to it, mind you malawi itself has its own british feel to it besides the same plugs and same side of the road and signs.
I was to share my room tonight with 3 of the ABC girls who were lovely and fun. I didnt mind this at all becuase I wanted to get to know everyone and they were keen to swim where as other internationals werent. With the thoughts of my cousins wife whos a Doctor saying go for it when I was back home... I couldnt help it, when the opportunity arose, I was straight in there!

 our stay was right on the lake with a reef right there ...had to be snorkelled !:) 

My new friend Shar (one of the US team) was very up for joining me which was fab, we had a swim with the ABC girls and then rented a canoe which was so much fun. 

 allinane, prisca and patricia and my home for the night.... newts crawling on the walls, lake view. FAB :)
We finally had a chance to chill in the company of eachother and get to know eachother outside of our common goal to help those in malawi with hearing difficulty.

Our one day and night here did not feel long enough ... will be a future visit here one day.

Karonga

Travelling to Karonga in the north took us a long 11 hours in our little minbus which would be part of our home for the next few weeks. The scenery was beautiful... vast landscapes, glimpses of the lake (anticipation and reminder of temptation - No to swimming! ) and monkeys chilling in the middle of the road .

Our time in Karonga was educational and obviously fun, we were to spend two full days there testing all the children at the school for the deaf and have a clinic at the karonga hospital. Peter informed us that due to a oil australian company working in this area they were to help fund health facitities for locals especially the school for the deaf therefore every 3 months he was to be flown up to Karonga to the school. So the main focus of our visit was to test and establish those needing hearing aids, and to train or refresh the staff in the basics and peter can later fit the children. I spent both days at the school. The first day we were welcomed greatly by the headteacher who was so pleased to see us, especially peter who he had met before.  the first day we tested all 50 children age between 6 - 18 and some of the family members too (some children and parents had there health passports which helped to understand their hearing loss if they had meningitis / mumps or malaria - quninine or anything else ototoxic written down) The teachers at the school put on a fabulous dinner each day we were there enzema , sauce, meat and vegtables.. delicious. . Day two- was to focus on those possible non-organic cases and training sessions for teachers. I was given the task of training audiometry with the teachers. At first i felt a little nervous but then I realised I know how to do this inside out so just go with it naturally, I really enjoyed the teaching session and tried to make it an interactive as possinle so they learnt they basic principles and then had a go testing me and testing eachother. 

one of the class's at the school

Jean one of the lovely teachers and I 

 Two others teachers at the school which I did my teacher training session with

 children waiting under a tree in the shade to come in for their hearing assesment

 my testing station 

 some of the fab children at the school - very good at their ASL 

the school raise there own chickens and pigs that can be sold to raise money for the school or for food to feed the children. 

Leaving Karonga was difficult, 10 children had been found suitable for HA's, others were not and it was diiffuclt to explain that it thier hearing was too bad for  a hearing aid. They felt disapointed i guess because as soon as they new we were coming their was hope thier hearing would get better. One older girl even offered to pay to have one however her hearing was just not suitable, it was all a little heart breaking and it was something I had not prepared for coming on this trip. 

The US team arrive

Third day in Malawi was a busy one. Bec and Peter were hosting a large party this evening for the all the team for the next few weeks, this was to include Dr Ingrid Mcbride and her AuD students at Arizona University, the student audiology technicians at ABC, the one ear mould making technician and the bartlett family. This ment we needed to get ingredients from the local market. It was a little market on the side of the road fresh vegetables and fruit very large and looked delicious.

After coming back from the market I joined Peter and 5 ABC students (part of the south team - whos main focus of study in ABC is mass communication) they were discussing how they could make people in malawi more aware that there was now a clinic in ABC for hearing problems. Helped with the discussion, ideas and then rebbecca got a call to say there was a walk in down at the clinic and if I could go down to see them. Was a perfect sunny day as near always in malawi and a stroll down to the clinic seemed lovely. I brought Chicondi with me one of the students to assist, watch what I did and help translate if there was a problem. It was child to be tested brought by her uncle. We did have a problem with communication due to the niece speaking one dialect and the uncle another, chicondi could not translate for the child but to the uncle. Some interesting things started to become now apparent while working on my own in a developing country, when there is a language barrier - accuracy of results can be difficult-- non organic ? or do they not understand what to do. Objective testing is vital, with tymps and with OAEs which backed up the results.

The stroll back to the house was nice just to see kids happily running around, playing tennis. The ABC did seem a wonderful place. The next task of the day was to pick up all american volunteers that were now to join us from the airport. The first glimpse of the 6 americans were they looked tired, exhausted and each were carrying "action packers" a term new to me. A large heavy case box with equipment and tools.
I was thinking these people are obviously inspired by the same spirit to be here so they must be great people.
The party was a great experience for us to all get to eachother, each international was to pair up with a malawi student and we had to then find something we had in common and then play a game to guess whos common interest matched the pair...was a good get to know you game, welldone peter. Leaving the bartlett family that evening I felt said I had felt so welcome there felt part of the family.

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We carried on to where we were all going to stay for the night - safari lodge.



our doom room that night, was quite a shock after sleeping alone the nights before.

 

Our trip the next day was an 8 hour journey up to the very north of Malawi . Very excited, could hardly sleep for the adventure ahead....

First few days at the African Bible College

Day 1 - Arrived in Malawi at 10.30 am flight was fine had some nice breakfast travel food. Getting of the plane I met a lady called Hannah who was a GP in the UK and she was travelling Africa. Day 3 of taking my anti - malarial medication and no apparent side effects. It was a little daunting coming through the doors of the airport, lots of stares.  Rebecca Bartlett one of the Australian Audiologists (currently residence being malawi) picked me up and it was the start of the Malawi adventure.

We headed off to the African Bible College, where the Bartlett family live and where their audiology clinic is based. We did have a run in with a traffic police lady (this apparently can be a common occurrence to check the car is insured, there is a normal upfront penalty of 5000 kwacha if a problem is spotted by the police.

So first entry through the ABC security gates we enter what looked like an american style compound, beautifully green an well presented buildings. Quite the contrast

 to the slums right opposite the ABC. 

Rebecca showed me to my room for the first two nights, lovely room and once id settled in and met Jess, Brianna and Elouise. Rebecca took me to the clinic for a guided tour. 

I quickly learnt there are differences and simularities between people who can and cannot pay. All equipment they had was gratefully donated and was in good condition. Also opposite there current location they were soon to start building a purpose built sound proof structure which would allow all ages to be tested even babies/toddlers who would normally have to be seen in South Africa. 

Getting to malawi

So We set of to the airport June the 3rd my dad and  I. He was wonderful drove me to the airport helped me with my bag, bought me dinner and kept me company till I had to go through to passport control. This was easier than expected. I saw the big xray scanner which thankfully I did not have to go through (it looked scary) . I also didn't have much time to wait the otherside thanks to dads company and I was soon getting ready to board the kenya airways flight to Nairobi.

The flight itself was fine, blanket to cwtch up in and food included too. I have not been on a long flight before but 8 hours I felt did pass quickly, the lady (whom a little large) next to me appeared to have bought both seats which was also nicer for me I had more room.

Arriving in nairobi was OK getting used to no longer using the british pound and not using the internet was a little tricky esepcially with being a little sleep deprived.

Anyway on to lilongwe ...Malawi :)

Malawi trip June 2012

In less than a weeks time I am off to Lilongwe in Malawi for 3 weeks. I have been a qualified audiologist for three years and this is my first trip to use my skills abroad. I am very excited about the trip and preparation over the last few months has been key.
 I have learnt alot recently such as:
- what is needed for travelling (bought myself a good tough rucksack which should hopefully last for other trips too)
- essential medications and immunisations ( had my last rabies jab last week, which was swollen for a little while)
 -  language, culture and currency (introductions in Malawi is very important, before doing anything people like to get to know each other, before having a hearing test e.g, ..so I have learnt some basic chichewa, (native tongue) to help me get by. English is spoken in Malawi, however in some rural areas chichewa is more common.

There has been alot of changes in Malawi recently since President Bingu wa Mutharika died (president for the last 8 years) and a new president Joyce Banda (Malawi's first female and Africa's second female president) came into power April 2012.  President Mutharika fell out with western donors and expelled the British ambassador last year and so British aid was withdrawn.
Malawi is one of the poorest countries in the world, with an estimated 75% of the population living on less than 60p a day. Mrs Banda not long in power has started making big changes... she sacked the chief of police chief peter Mukihito over the poor handling of 19 people who were shot dead last July in anti- government riots. The Malawi currency - Kwacha has also been devalued 33% and western donors such as the UK have thankfully restarted aid again. So all changes to be a good thing? We'll see, I think Mrs Banda is definitely a lady with some balls! strong willed and will hopefully have a positive long needed impact on the country.

In terms of audiology - there is an extreme lack of audiologists in Malawi and other subafrican countries. It is actually said that 2/3 of of all hearing impaired individuals live in developing countries ( world health organisation figures) . The incidence of permanent and significant hearing loss is vast due to meningitis, malaria, measles, ear infections, ototoxicity and thats to name a few. With a lack of professionals and medical facilities/equipment alot of those with preventable hearing difficulties are going untreated. Currently Malawi has two permanent Australian audiologists - Peter and Rebecca Barlett from a charity called ears inc who have set up a clinic in the African bible colleges community clinic which is going really well and has also become a training centre training local people. There is also 1 ENT physician and 2 technical officers trained in ENT. 1 retired nurse and her husband who work with Bartletts and one school for the deaf.  The country has a lack of schools for deaf, and the few they do have are each at full capacity.  A UK charity "Woodford Foundation" who got involved in schools for the deaf  in Malawi especially in the north and looking alot at children with a hearing problem in mainstream schools. http://www.woodfordfoundation.org.uk/ . Additionally on my trip I will also be joining another volunteer group who are coming over from Arizona USA. The fantastic Dr Ingrid McBride with a group of AuD students will be going over too http://hearingforhumanity.org/ . Its all exciting stuff and it makes me happy that there are people dedicated to helping this cause.

this little organ is very important !

Right well theres my intro to "the people and their ears of Malawi..and my upcoming adventure". I better get back to getting the last few things sorted for the trip. :)