So, last Thursday I woke up in the middle of the night and actually thought somebody had stabbed me in the chest. My first consideration was that Laura had finally had enough of me and lost control. This would not have been a real surprise but as I moved my hand onto my chest there was no hole and certainly no knife.
“Laur! Break off that mosquito coil, I think it’s poisoning me!” I manage to squeeze out under one big breath, which caused this invisible knife to sink yet further into my heart. Laura replied, groaning a mix of “What time is it?” “What the heck is wrong with you!” and “Are you ok?” all at once.
I like to blame Laura for most of my problems so the obvious response was “You put that blinkin’ mosquito coil on and I think it’s tearing my insides apart!” Anyway, I made my point and she turned off the coil but this wasn’t the end of my problems. The next morning I could not eat breakfast and by lunch time it was painful to even sip water. By the time Sunday came, I had decided enough was enough and the mosquito coil could not have been to blame, so sent Laura on a mission to surf for the answer.
So she did. The World Wide Web, answer to all queries gave us an answer. According to the symptoms I had described, the computer diagnosed a normal case of Esophagitis. Basically the web page explained that I was a muppet, had taken my anti-malarial doxycycline tablets at the wrong time a day, without food and with not enough water. Oops. So in return for being male and not reading instructions, the female part of my brain was punishing me by telling my stomach that it needed to start stewing up a load of acid and pushing it up my oesophagus. My oesophagus had responded by curling up into a ball and crying like a baby, thus creating major pain that mimicked Laura stabbing me in the chest.
On Monday I thought it would therefore be a good time for us to join a group and complete a 16km walk to a waterfall in 30-degree heat. Not being able to drink water was a slight problem, but feeling like ‘Mr Soft’ from the SoftMint adverts whilst walking around was an unrecommendable but slightly enjoyable (not to mention totally legal) high. This said, I had finally given up. I needed medical attention.
Tuesday we walked to the local dispensary and explained the symptoms and what we had read. Clearly out of his depth the health practitioner told me to make my way to Mzuzu, the capital of the north, to get further treatment. We returned to the lodge and left immediately towards the tarmac and Mzuzu. Diesel is still a problem in Malawi so we decided to get on the bus to save any fuel we could for the lodge.
Diesel was more of a problem than we thought. Sitting on the side of the road with the sun scorching down onto the top of our heads we saw no more than two buses go past within the first three hours. It wasn’t pleasant, not for either of us. But adding the fact that I couldn’t swallow water easily and then that little mud-hut shop only stocked coke (which must be more than Ph7), my day was getting worse.
So what else could happen? Well, in the distance we heard a clatter. Being just outside the forest, we presumed this was some loggers throwing some timber off or onto a truck. It happened again and this time it sounded much more familiar. All of a sudden the sky turned black and the hairs raised on the back of my neck. BABOOOM! CRASH! The clouds exploded. It began to rain. Wait, rain is not strong enough. I mean it poured, it tipped it down, it emptied itself! I say it rained, yet this wasn’t rain as I know it. This was like rain on speed. Big, immense, golf-ball like droplets where being flung to earth by a million little men with catapults, sniggering as they watched us flee to cover. They bounced from the tarmac almost as high, so that even the flabby skin under my chin was getting a shower. Within minutes the roads, the mud sidewalks and the indigenous woodland were all a part of intermingling streams that were racing downhill, each one trying to get there first. We managed to get cover under a thatched roof veranda, backed up against a mud wall but even this didn’t work as a suitable buffer between us and the rain as the drips found their way through gaps in the roof and continued to soak us!
Enough was enough and we decided that we would get on the next bus to pass whether it was heading to Mzuzu or the closer town of Mzimba from where we could change and get a further bus to Mzuzu. A small minibus approached with a cardboard sign ‘Mzimba’: it appeared full to its limits but we are quickly learning that in Africa, a bus is never full…. There is always room for 1,2,3 more bodies. Always.
We got on and managed to squeeze up next to some people, chickens and bags of maize. It was, to put it nicely, cosy. As the bus slowed down to let some people off a few kilometres down the road I think we all breathed a slight sigh of relief. But as the matola opened its doors, yes you guessed it, it was time for another three people to clamber onboard. One with a conveniently oversized suitcase, which pushed the ceiling of the bus to its limit as he perched himself onto a metal arm-rest and the case onto his lap. Laura managed a polite smile too as a teenage girl sat on her lap without a consideration as to whether it may be considered as rude or an invasion of personal space! “We’re like beans in a can!” I announced to my fellow passengers who broke into laughter. The guy whose job it is to organise passengers into this Tetris like existence sucked his teeth. For the rest of this blog I will refer to these guys as ‘Joey’s’
Driving is very much different here. At no point does a driver of a car, bus or truck think of pedestrians. Vehicles have right of way and if you are in it, tough luck. On arrival at Mzimba this opinion was proved fact. Leaving the Heinz tin to change onto another rickety excuse of a bus which was bound for Mzuzu was no less eventful than the journey to get there. Once the Mzuzu bus’s Joey had spotted us, he knew he had a catch.
“Where are you going bueno?” Bueno meaning something similar to ‘brother’.
“Mzuzu,” I said, disinterested as you must seem to survive.
Mzuzu Joey sprung into action! He had a potential mzungu passenger. Mzungu’s tend to pay a couple of hundred kwacha (less than one pound) more for their journeys. And there were two of us! So he proceeded to get the bus, which was a decent size, probably containing 30 or so seats, to back up and park under the iron sheets, so that we could get on whilst avoiding the rain and small lakes which had appeared in the bus station from a couple of hours rain. Nice move, I didn’t fancy walking out into the gun pellets. If he managed it, he had my custom.
“Bueno, zakuno!” (brother, come!) he called to the driver. So he did, he reversed towards tens of people who were patiently waiting under the shelter on wooden benches. He would stop before he reached them, wouldn’t he? No is the simple answer. This resulted in ladies with children strapped to their back, young children and old men diving for safety, dragging benches out of the way before the bus screeched to a halt.
“Get in,” the Joey said.
“Pepheni!” (sorry!) I called in the direction of the scattered waiting Malawians. They laughed and called out thanks in tumbuka. To them, this was just usual business at their bus station. For me, craziness! But craziness I’m getting used to.
The three hours towards Mzuzu consisted of a leaking roof, no leg room, crying babies and a worsening pain in my chest. I started to miss home. Things I have never appreciated in the UK, things I have often grumbled about, started to seem really good. The NHS was something I was about to add to that list.
Arriving in Mzuzu, the even larger, more frantic bus station sent shivers down my spine. A guy who’d spotted us on the bus from the gate followed us and greeted our arrival in his city. “I am cheapest taxi.”
“Good, take us to your car.” He must have sensed my loss of care and energy from the window of our bus. His well kept Toyota took us to the hospital.
“6km, 1000 kwacha!”
“I’ll give you 500 hundred and maybe call you later for another ride” I mumbled,
“Ok, give me your number sir.”
“No, you give me yours. It’s no good you calling me guessing when I need a ride is it?”
He gave me his number and asked me to flash him. I think that means to give somebody your number by calling and hanging up before they answer. I kept my trousers on either way.
Mzuzu Central Hospital was, other than the new parliament building in Lilongwe which has been built by the Chinese, the most impressive building I have seen in Malawi. Not big, not flashy, but clean, well laid out and spacious. For a hospital it didn’t have that whole death feeling about it either. Myself, Laura and Yami, a guide from the lodge and all round nice guy, walked into the emergency room and asked to see a doctor.
“He is not here,” (Shock! Malawians are rarely where they are supposed to be.) “He will be here soon.”
“Look,” I replied. “I’m not being funny but it’s been a long day. We have been out for seven hours to get here. You say to me ‘soon’ … is this a ‘5 minutes soon’ or a ‘Malawian 5 hours soon’”
“I don’t know, he should be here.” She replied whilst looking the other way. Yami interrupted and spoke in a calm, quiet and very soft tumbuka. He turned to us and said “We can take a seat.” Assuring, maybe.
Eventually we were called into the doctors room. I sat down and explain my symptoms. I added the fact that we’d done some of our own research and that my doxycycline could be to blame. As with many doctors, this guy decided that I was just a ‘normal and stupid being’ and that there was no way that as an untrained person, Laura or myself could have identified a problem and diagnosed it accurately.
So he sent me to the Radiology department for a chest x-ray, with a note on a scrap piece of paper saying Aspiration Pneumonia.
“Pneumonia!” “Am I going to die!?”
“There absolutely to chance it’s pneumonia, this is ridiculous!” Laur replied.
I hoped not, but went for the x-ray and got it back within a minute to take back to the doctor.
Returning to the emergency department and my not so friendly Malawian doctor I felt as though the whole trip was a waste of time. I was going to get treated for pneumonia, which I was 90% sure I didn’t have, and keep these horrible symptoms which had not only taken food from me, but beer also, for almost a week!
I handed the x-ray to my new friend who snatched it out of my hand and held it up to the light. My ribs looked just like the ones on pictures of normal skeletons. This was reassuring, and although I did not know what I was looking for, my eyes were locked on the picture of my insides.
“Hmm, I will need to discuss this with my colleague. Just wait outside” he announced. A second opinion … that might help.
As we waited in the lobby, next to a guy who had seemed to have destroyed his shoulder and another who had cut his toe, I sat cautiously, with no idea of what would happen next. I had lost faith in the doctor, the receptionist didn’t care, and the journey from Mzuzu to Lilongwe was looking like a forgone conclusion, so that I could get some ‘proper’ advice. Until…
A mzungu doctor walked through the door. Not just a mzungu doctor, but one with an English accent! “Alright mate?” he calmly asked.
‘Much better for seeing you!’ ran through my head as my lips muttered “Erm, kinda!”
I quickly ran through the symptoms of my problem with my fellow countryman before he began asking the question “Ah, are you taking any..”
“YES! Doxycyclene!” I called in a sort of excited ‘you know what you’re on about’ voice.
Dr Mzungu turned to his colleague and motioned to hit him over the head with the chest x-ray. “What did you take one of these for, you Muppet!?” he joked. We all laughed. He continued to explain my difficulties almost word for word as we had read them on the internet search. Gastritis was the diagnosis. Relief is not quite a strong enough word.
Dr Saviour wrote down a few things I needed to get from the chemist, Omeprazole and some Magnesium Trisulphate. Through my ignorance, I had never heard of either of them but the sounded right and therefore I was happy.
“You’re chest looks fine by the way.” Dr Knight in Shining Armour noted as he walked out of the office with a cheeky little wink that suggested ‘You’ll be fine!’ He had just told us that he was actually based in Blantyre, Malawi’s largest city in the south. He was only up in Mzuzu for two days each year, this was one of them and it was after working hours. My luck was definitely in!
So we left and I got my tablets. Only one thing had left me disappointed from the day,
“No beer, no smoking, no spicy food … for another week.” None of those actually came to matter, as I couldn’t swallow for the 5 days following.
I am all well now but the one thing I have taken from the experience is how lucky I am to live in a country with a good health service. I have since learnt that the gentleman who I first saw at the hospital was probably no more than a health practitioner and not a doctor but his diagnosis was wildly incorrect. It can’t be helped to think of how many others are misdiagnosed daily. How many lives does it cost and why?
Well the truth is that healthcare in Malawi is improving rapidly. There is a training school for doctors in Blantyre and more are qualifying. Unfortunately vast amounts of them move abroad as pay is hugely increased, with South Africa and the UK usually being the destination. I have heard a fact bounded around and whether it is true now or not, it certainly used to be.
‘THERE ARE MORE MALAWIAN DOCTORS IN MANCHESTER THAN MALAWI.’
Something to think about.
