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Chris w Malawi

20 paź

VOICE

July 2013

 

Five days ago I returned from Malawi, where i had been for almost four weeks. I had often thought whilst there of the upcoming creative writing meeting and the given title for that day. “Voice” a word, a name, a sound but much more. Voice declares the presence of a person, some identity, someone crying, speaking and wanting to be heard and recognized. Voice, a word so powerful and yet so many of those who have the human capability of speech, have no voice. But of course we all have voices, and we are heard, even if not by many. The children in Malawi, whose presence by the side of the roads, those children playing free, shouting, laughing had made a big impression on a visiting purveyor of surgical instruments, who for the first time in his life was out of Europe and in Africa where as he contrasted their freedom and carefree joy with those children he knew back at his home in Scotland,

a voice had woken inside him, asking whether those children at home with all their digital wonders of computers, televisions and gameboys, but confined play areas had the better or worse deal for life in the 21st century.

 

I also heard voices, many voices whilst in Malawi, even though I did not travel far from my base at a Lodge close to the centre of the city of Blantyre. From this lodge, an extended home run by an elderly, kind and dear Malawian woman, situated on a hill overlooking a shanty-like part of the town, and with views out to the hills that rise like large ant-mounds within and around, and with views out further to the moutains in the distance and up to the clouds that sometimes rushed, and sometimes lingered over the hills, clouds and mists that draped at times the valleys and filtered the colours of the rising and setting sun. This i called the voice of distance and perspective, since how often do we in city life have a chance to look out over its structures and take in a bigger world. Too often do we not hear only the voices of those near to us but from this Lodge and from its balcony shared by all its residents as a place to eat, talk, work or sit and meditate and be open to the voice within of the heart or to the voice of the earth which we share.

 

Each day, each morning as I waited for my friend to pick me up to take me to the hospital, and each evening if i should return before dusk, i would sit on that balcony and acknowledge the message of the earth and hear of the gifts it gives us with open arms – a place and home for our bodies and souls. I also, though, heard its cries of anguish as we despoil and take for ourselves its fruits of beauty, forests, and colour. For Malawi wishes to develop and become like the rich occidentals who have everything, Malawians who wish, as we have done to replace, the gifts of Nature for concrete and tarmac, and replace life by things, realities by images. Few of Blantyre’s hills now have trees. Mountains have been laid bare, every tree cut down for money by the rich, or for fire wood by the poor. And the creep of urban life makes its way up the slopes of the nearby hills – the dwelling places of those who have abandoned the countryside. Perhaps one day, the countryside will abandon us.

 

Yes, it was a powerful time for me; a voice did speak to me, not just that of our earth, an earth mocked, ignored and abused. For as I sat on the verandah of the Lodge, as I did each evening and during an afternoon if I should be free from duties, I had time to listen to the voice of life and thought.

 

Voice gives and brings meaning. Voice distinguises itself from noise by giving messages, and messages give us purpose and bring us to understanding. Four weeks, away from from the immediate pressures of work, four weeks away from those who speak insistently to me, time for me to speak to me and for me to listen to the voice and the rhythms of a life that go beyond me and call me to new adventures and discoveries.

 

Each working day i made my way to the hospital, the Queen Elizabeth Central Hospital, founded in 1954 in the time of British Empire and still in its core much like those days – and still the tertiary hospital for the country, a hospital where people come when disease has become too much to ignore. The woman on the mattress by the wall, whose ranula of the floor of her mouth had become so large that she could neither speak nor eat, and barely drink. Another woman whose eye, many weeks already non-seeing, was now two inches in front of her nose, pushed forward by pus oozing slowly over the weeks into her orbit from the frontal nasal sinus. And the six year old child with no voice, and almost now no sound, as he was carried from the hospital’s casualty, almost without breath. Thankfully, my friend and colleague, skilled with the laryngoscope was near and able to push a tube past the obstructing vocal cord viral papillomas into the trachea, and the child survived to regain again voice. To speak of all those who suffered silently would take pages, books, encyclopedic volumes, but sometimes one story can speak so that others will hear and listen. Whose story that will be though, is impossible to predict. Could it be the man curled up in pain on the floor of the surgical ward, his left arm not functioning properly for he had an irregular hard lumpy cancer of the lower neck arising from the thyroid and infiltrating into the brachial plexus, and for which he had received no diagnostic or therapeutic procedure from the time it had started. He, like others come when it is too late, to change the course of the disease. Others come and are offered hope. They wait, sitting in the corridor, to come in for surgery – but there is not time, nor equipment nor medicines for more than a few. These have no voice. They suffer silently, unheard. But always some voice does call and some respond.

 

Two years ago, an announcement in Malawian newspapers for a new 18 month diploma course in ear, nose and throat surgery and audiology appeared. A popular invitation for the medical assistants across Malawi who after two years of training provide much of the primary and secondary care across Malawi as nurses are few and doctors even rarer. In ENT, for the 15 million population of Malawi, at the last count, there were just four audiologists, three clinical officers dealing with ent, and just one ent specialist, a surgical specialist named Wakisa Mulwafu, a man who loves and is committed to his country and who with a multiple pitches of tone, story, and emphasis has already gained many funds from within and outside of Malawi and had built an ent clinic with rooms now equipped with one microscope, some suction machines and some audiometers. He has also raised funds and had built operating theatres (two but yet to be equipped) and a 20-bedded ward (still empty, for it awaits those beds). The diploma training programme for clinical officers was initiated by him, inspired by similar programmes that already provide orthopaedic, anaesthetic and ophthalmic services across Malawi.

 

And during my four weeks in Malawi, my third visit there over the past nine months, i met again and heard the voices of those 15 medical assistants, chosen from over 100 applicants, and enrolled as the first cohort of locally trained ENT specialists. Their voices now have names, and their voices are beginning to have biographies and characters. I am learning about their ambitions, their worries, the motivations that brought them onto the course. I also wanted to give them a voice in a more formal way, a collective voice that others could read, and take note of. In a world, where the voices of people are drowned out by the agendas of the media and of commerce, or the demands of objective scientific evaluations. This seemed important, and so I conducted an open qualitative interview with each of them, asking them questions that they together, had chosen for me to ask, and which i later formally wrote up as their testimony for the organisers of the course, which had included myself, and others who might want to understand what it means to want to do better for oneself and others in a land where opportunities are few.

 

They spoke of their desire to move forward in their careers, gain knowledge, help others. They recounted seeing cases of ENT misdiagnosed, mistreated and of their hopes to bring ENT services to district hospitals. They recognized the difficulties, the absence of any equipment and importantly the need for professional support and encouragement in conditions where patients may well expect far more than at present they can give. And of course, in a country that is poor, they talked of their own needs for improved standards of living for themselves and their families. They addressed the content and organisation of the course, of lecturers who did not turn up for classes because they were not paid, of the bad accomodation at the college and of the terrible food they are given to eat – eggs and maize meal each day after day – for the daily allowance provided by the government to their hostel is just one dollar a day. They have few books, limited access to computers and internet, and they know that in 6 months, most will return to district hospitals to provide ent care without, as yet tools, instruments, access to investigations. And yet despite this, each was filled with hope and the knowledge that at last, they were being given a chance to learn more, to pursue a career and move into life and a future.


One voice of those 15 medical assistants spoke especially to me. In April, he had not been around – he was recovering from a motorcycle accident. This time, he told me the story of that accident. He had been travelling from his farm alone through the deserted hills back to Blantyre as dusk fell. Half way along his 120 kilometre journey, the tyre of his motorcycle had come off, the front wheel spun back on itself and the handlebars hit him in the abdomen as he came off. He was alone, darkness was approaching and he was weak, unable to get up. He also had pain in the left shoulder, a sign that he knew indicated a ruptured spleen. Hope came as three people approached along the track, but he heard only how they thought he might be a decoy and bait for an ambush and robbery, and so they walked on, passing him by. Half an hour later, another person approached, and this time, a person prepared to help, which he did by repairing the motorcycle wheel and helping seat the injured medical officer back on the bike to motor on by himself, since the passer-by was heading in the opposite direction. He managed some 15 more kilometres to reach a village, where too weak to go on, he asked for help which was given him with two villagers siting on the motorcycle seat, one in front and one behind of him, keeping him upright and preventing him falling off, and so they took him another 10 kilometres to a small rural hospital. There, there was no surgeon but there was an ultrasound machine, confirming a ruptured spleen, intravenous fluid to resuscitate him with and transport to take him another 30 kilometres to the next hospital, where he arrived around 2 in the morning. At this hospital a surgeon was available, a non-medical clinical officer but there was a problem – no anaesthetist, or rather the anaesthetist was in bed too tired to get up, or pehaps just not bothered enough to get up. Only around 6 that morning could he be persuaded to anaesthetise my friend, the trainee clinical officer. At last, close to his end, he was taken to theatre. The ruptured, bleeding spleen was removed and the three and a half pints of blood in his abdomen returned to him by auto-transfusion. He gratefully shows me the scar on his abdomen stretching from his xiphisternum to pelvis, and tells me that his life was restored by the grace of God. No doubt this is true but it was also restored by those willing to listen to the voice of God and to make care an essential character of our world.

 

The story of this medical officer had echoed the voices i had heard at a meeting two months before in London calling for essential surgery to be made available to all and calling for a global training programme in 15 essential generic surgical procedures so that no one would cry out for need of an essential surgical procedure and be denied it. And so I ask you and others to give voice to the global campaign of Fair Health for All.

 
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