A Week of "Firsts"

First time I really felt like a local

I gave Andrea (Canadian physio student here for four weeks) a full day tour of town to help her settle into Malawi life, so that she could get around town safely and confidently. It was my chance to pay it forward in terms of helping another outsider, feel more like an insider…..and it was great fun! I totally exhausted the poor girl, it was about 43 degrees and I gave her the extended tour… so we covered a lot of ground and crossed a lot off our list!!

It helped me see how comfortable I have become here, and how much I have explored so far. I was pleased to be able to share with her another side of Malawi that many of the azungu’s don’t ever see. I loved seeing the things she was amazed at, and things that overwhelmed her, it gave me an opportunity to see this amazing place through new eyes again, and I loved it.

First time that I cried myself to sleep

Ok so that’s a little depressing. But I have realised that it’s not a true representation of updates, if I don’t share with you the tough times as well. Last weekend was not a good one. I Just felt the pressure of a few to many emotions all at once, felt a bit stressed about some decisions I was needing to make, was pretty exhausted from a challenging week of dealing with all sorts of things that had caused me to think, reflect and analyze myself more than necessary, and felt pretty isolated on top of all of that. So it was nice to have the distraction of taking Andrea around to take my mind off things, and contrast some of these feelings with much more positive ones.

It was a passing feeling, so that’s great. We all have those days that are just really ordinary, but I’m certain that your ability to manage those days have got to be easier if you’re not on the other side of the world from everybody who is really dear to you!! And on the other side of the world from a phone to ring a friend, GeeCees to have a hot chocolate and herb pizza or the video store to watch a movie and eat chocolate (these are some of my favourite things to do when feeling yuck!!)

First excellently timed candlelight dinner with some Aussies

Lyn & Ros arrived at SOS on Sunday afternoon after 48 hours of no sleep, terrible airplane food, lost luggage, stolen shoes and stolen glasses and they were greeted by no water or electricity and me in the mood I have described above. And yet we ended up having a fabulous evening, turning our days around!! They had brought gifts for me including Adelaide’s own Haigs chocolate (which Ros declares is the best chocolate in Australia, and right now as I eat the last piece, I would have to agree!!) I also now have packets of parmesan cheese and the weekend Australian newspaper. I have since methodically read every single word of the newspaper, and loved every bit of it. I collected water for them to have a wash, and invited them over for one of my famous “no electricity meals by candlelight, which I have now mastered to perfection. And once the electricity came back on later in the evening, I treated them to my newest invention of cinnamon French toast with cooked banana’s and mangoes…sounds weird, but its truly a taste sensation (if I don’t mind saying so myself)

ps Lyn & Ros are both AVI volunteers who were living in Malawi about 2 years ago and have returned here for a holiday.

First experience of home visits

A very humbling adventure in which I was immensely priveledged and blessed by new friends with the biggest of hearts. Home visits are a time where we deliver equipment made from any donations received here, such as walking frames, CP chairs, toilet boxes, wheelchairs and standing frames. All of which are locally made equipment from our very own SOS carpenters, welders, tailors and tinsmiths from the vocational training centre. And we also use the visits as an opportunity to check up on people who havn;t attended for some time, or as sorry visits after the death of a child. It has been an amazing experience to visit the homes of people I have met numerous times, and villages I had only heard about. I now have a new understanding of our mums commitment as they travel from out near natenji walking between 1 and 2 hours just to reach the bus pick up point to arrive to therapy on time, some waking at around 3 or 4am to do so. I can now also see that many of the mums wear their best clothes, and put on a brave face for us at the centre, yet to see their homes it never ceases to amaze me at how so many people live. So many families have a home, but nothing inside at all, used only for a shelter. One trip we spent the entire day out on the road, visiting only 4 homes, as it took so long to find them, and once locating the village, it was another challenge altogether to locate the right house, and once locating the house, tracking them down from the market or in the fields to conduct the assessments, or deliver the equipment, it certainly was a time consuming venture!

The way people live is just amazing. It’s strange to think that I am living amongst the most priveledged of Malawians here in Lilongwe. And yet as you can see from my updates so far, it is still far from our lives at home. The home visits have taken me to villages and homes that are a whole other world to even my life here in the village. I complain of no water and electricity when it’s been a few days in a row. I don’t even know the stats ….. but it would be more than 90% who don’t ever have water or electricity. I have been so blessed by the excitement as the mums have seen us arrive, and the flurry that follows to make us feel so welcome. The greetings are vibrant and excited, as time passes more and more interested onlookers gather around the house, as no one wants to miss out on the visit.

I have left some homes filled with so much emotion, at how much love they have shown us, and how much they give out of the little they have. I have been so touched, humbled, and filled with a new sense of responsibility and commitment to them after seeing the effort it is to bring their children each day to see us for therapy.

We would drive along roads that hadn’t seen cars for months and months. passing women carrying water on their heads, bunches of banana’s, baskets of ufa for nsima. Occasionally we would meet a home made cart, with wooden weels and axels, pulled along by cattle. And we were surrounded by giant fields being prepared to sow the maize.

The houses look sensational. Many houses are made from compacted mud, leaves & grass with thatched roofs, but they rarely look unkept, it seems the houses take on an art form of their own and often each village will have something in common, either a simlar pattern painted on the doors, or a different style of house, there is great pride in the little they have.

First meeting with a frog

I stood on a frog with bare feet the other day. I jumped much higher than he did the first time…. but then he leaped onto my other foot, so then we both jumped, and our short meeting was over. I no longer walk outside my home without shoes. As the seasons change ever so slightly, I am meeting new bugs and creatures everywhere!!

The first rains

Just wanted to share with you my first experience of the rain here in malawi….
I was going to visit my good friend Mary, it was sooo hot that much of the morning was spent immovable on the chair, bed, ground, etc. I am reading a book that I just cant put down, and im loving it. but little did I know the extent of the heat outside until I ventured for my walk to Marys. Its about a 20 minute fast paced walk up a killer hill. Just yesterday I had brought my first umbrella convinced that the rain would arrive soon, and I was pretty keen to use the umbrella as it really is the coolest one I’ve seen!…its covered in big yellow smiley faces. I figured seeing as I don t blend in to the crowd over here anyway, I may as well make the most of it and get an incredibly loud brolly!! So when I left the house armed with a giant bottle of cold water, slathered in suncream & mozzie repellent (its my daily beauty routine) while trying not to drop my banana cake. i attempted to analyse the sky, which was sporting some lovely big black clouds, that were screaming out that rain was near… but I often have thought that in the last few weeks, but they keep on their journey overhead without sharing any rain with us.

And as I walked faster and faster, the storm started really brewing, I made it to marys about a second before the downpour, and it was fabulous. We all ran outside, her two boys Asha and Innocent were screaming, laughing and running crazily around the yard covering themselves in mud along the way. We sat on her condi and enjoyed the amazing smell and cool air, it was fabulous!! I stayed for about an hour, but then made a run for it after there was a break in the sheets of water.

The walk home was just amazing, I really felt like I was somewhere else. The air was so clear and cool and fresh smelling. Can you believe there is a mountain of in the distance behind area 24 that I had no idea was even there. The haze of dust and smoke has obviously built up so much that you just cant see very far off in the distance. So I saw my home with totally new eyes. Every house has these giant drains surrounding them, and roads are often lined with big ditches that cars are often stuck in, and now I know why. The capacity of rain that hits is just so massive. Everything looked water logged, The once dry plain red and dusty ground completey changed appearance. It was now covered with millions of ants scurrying around, scattered with leaves and brightly coloured flowers that had fallen from the surrounding trees. We have amazing purple flowers, flame red, hot pink and the brightest of yellows. The puddles all over the roads were brightly decorated. They were all different coloured water from the different flowers that had fallen. there were yellow puddles from the pollen, red puddles and green puddles, it was soooo amazing, I’ve never seen anything like it, wished soooo much that I had a camera, but I certainly have a photo in my mind. The rain that was dripping off the roof was a dark redy-brown but I guess as it was the first rains washing 7-8 months of dust storms off the roof. Im not surprised, but I was surprised at the colour of our village. Until now I had thought the buildings were a much different colour than they actually are. So the village looked completely different with all the dust washed away.

Our village is on a big sloping hill, and I now see why there is a giant canal dividing the village in two, apparently it fills up enough that kids swim down it like rapids. That can’t be healthy.

I am told that soon every square meter of land will be covered in maize, and the rains will bring the land to the brightest and lushest greens imagineable, and yet this will be the time of the greatest starvation in Malawi, as last years crops storage will be rapidly diminishing now as they eagerly await the next harvest.

Along with the rain comes a whole new atmosphere in the evenings. The day times seem about the same, but another world emerges as the sun disappears, none more than when rain is about. There are frogs, and lizards, and every crazy bug you could imagine. Beautifully coloured moths that look as big as small birds…but they don’t look anything like birds…hmm… maybe a better analogy would have been that they look like giant butterflies.. yep that wins… although moths are usually bigger than butterflies… ok I’m going back to the first description.. so there are these giant moths that look just like giant moths, and they look simply amazing..hehe… and I’m reminded of just how much I love things that are new and different, I spent about an hour the other night taking photos of all the different types of bugs I was seeing… I was fascinated by bugs that I’ve never seen before.

But the best of all is the arrival of the thousands of ngumbi. Now this is a sight to be seen.

I cant really imagine what it would be like to experience a plague of locusts or something in biblical proportions, but I certainly feel like I have seen an amazing phenomenon. And one that would not be nearly as phenomenal if not living in a community such as this.

I had been told that the night after the first rains is when they come. Usually late in the evening. And the first night, brings the small ones, while the second night brings thousands of big ones. Ngumbi are flying ants in English. I think they are flying termites… to us, but here they are a once a year snack full of protein. The don’t say anything about that in the lonely planet books, and im certain in town the expats are shutting their doors and arming themselves with giant doom bottles, ready for a killing rampage. And yet, this will go down in my memory as some of the most fun I have ever had. The atmosphere was so amazing. everyone was outside running around catching handfuls which turned into buckets full of flying ants. It was almost like a festival kind of atmosphere. Everyone outside their houses, celebrating the rains with a feast of ngumbi

I think they only have one flight a year, and its obvious!!! They are seriously terrible at it!!! They are so easy to catch, The fly into things, suddenly drop to the ground mid flight, stroll along in the air as if on an afternoon wander so are remarkably easy to catch off guard. Even for me. I caught stacks of them.

you have to watch out for the double winged ones, as they are more juicy (eeww) some kids were armed with plates that they swipe through the air and smack the flies to stun them enough so they fall to the ground and then you catch them, others used buckets which they flew through the air in the direction of an oncoming ant and hopefully you caught some ( a bit like a net) they often flocked towards the lights.. the next day the ground everywhere was just covered with their wings. But no ants to be seen. So the best way to cook them is by frying them in a little oil after pulling off the wings... i really think they should try some garlic or salt or something...

First experience of the president

So we were driving along the road towards area 36 for home visits. All of a sudden Jameson swerved off the road in a terrible start and halted to a stop, now his driving leaves a bit to be desired on a good day, but this was rather odd, but not but a second later, a convoy of about 8 cars sped by (really really fast) with lights and sirens everywhere. Apparently this is how the president travels. I am rather pleased I have learnt this. As I thought that sirens meant some kind of emergency… as any westerner would… you really don’t hear them around here anywhere. If theres a fire. Put it out yourself. And if you need the police. You might have to wait until they find someone who has the key to get the money to buy credit for their phone, so they can ring someone who will get more fuel for the car, to drive to where the police car is so they can help you.

It seems sirens are reserved for the ambulance and the president only. And the rules are rather interesting. Get off the road, or else. I was amazed as we drove further up the road after jameson resolved our hasty trip of into the dirt, as we saw the outcome of two rather nasty car accidents, all of which had been caused by people getting out of the way of the president. Can you believe it is stated in government policy, that anyone hit, or killed by the convoy of the president whill not be held accountable in any way, as it is there responsibility to make sure they get out of the way.

First time I slept in past 9am since I have been here

Self explanatory really… gee it was good!!


First time I witnessed someone being hit by a minibus

And I hope it will be last. It really was like one of those TAC adds. He was hit at a rather high speed will standing stationary right next to our minibus that was about to leave the depot. The minibus that hit him never stopped. And from crammed inside our bus, we watched as he was flipped over more than 360 degrees and lay motiontless on the ground in front of us. It was horrific. After what seemed like forever (and maybe only a few seconds) he stood and then fell quickly down again in complete shock. There was blood all over, but not obvious where it had come from. He sat in what lookedlike immense pain and just cried. Our minibus backed up a little and lots of guys jumped out, but what confused me so greatly, was that no one helped this guy up, or out of the way of all the buses surrounding him. It was so strange. There were people standing and watching, but no one really doing anything. However not long after the guys from our bus had returned after obviously finding a spare bus and they all carried him to it and it sped off to the hospital. I wonder what happened to him, im sure he would not be a well man.


First trip to Zomba

havn't been yet...leaving tommorow... pretty excited, supposed to be an amazing place!

First time i took the wrong USB to the internet cafe

GRRRRRRR so all the updates i prepared and emails....are sitting at home... not happy!!

happy snaps

I have updated with a few more photos...

http://www.flickr.com/photos/tjolly/

it takes soooo long to upload them, so sorry for the small numbers.

my short walk through the health crisis here in malawi

Kamuzu Central Hospital

I was volunteered to escort two patients and their families for review by a paediatrician in town… this is the girl who has never actually been to the hospital, or has any understanding of how the system works, or doesn’t yet speak fluent Chichewa... Hmm.. I was a little baffled, but there really wasn’t any other options, we are in the middle of workshops, lots of staff shortages from illness, it was a big day with lots of kids, so we had a quick meeting at the start to decide who would take on this responsibility, and despite much protest, the job was given to me! I was given heaps of instructions about where to go, who to talk to, how to make sure you don’t line up in this line, make sure its that line, and make sure this.. and make sure that… ahhh… it was very scary, anyway, just as we were pulling out of the village in the bus, another vehicle returned with the home visit crew, so morgan jumped in with us so I wasn’t alone. We were taking two children for review. A little two year old boy with downs syndrome, and terrible heart issues requiring investigations, and another brand new three month old baby girl, with severe failure to thrive, no suck reflex,grossly underweight, not breast feeding, and basically slowly starving to death.

So I conducted a swallowing assessment on this tiny tiny baby as we bounced around in the minibus toward the hospital...The reviews were rather uneventful, the doctor reffered both cases onto a muzungu doctor from the UK who was fabulous with both our babies, and we were soon on our way, although the minibus to pick us up was more than an hour away. Neither mum or baby had eated anything all day, so I searched around for places to buy some food and drinks for them… but its certainly nothing like royal childrens hospital with any fancy Macdonalds or Cafeterias… but I eventually found some water, coke and banana’s.

The mums settled under a tree, and Morgan and I set off for a tour of the hospital. We ran into one of our SOS mums who directed us to two of our children who had been admitted, one with pneumonia and the other for malaria. so we spent some time visiting them......and here begins my reason for sharing my hospital experience with you. The tour with morgan was absolutely overwhelming. I saw nurses only once, which was in the high dependency unit, of which there are many, and there was only one nurse. All patients admitted to hospital have to have a friend to stay with them, to bathe, care for and feed them.

Often in hospitals at home, to describe your hospital you would firstly indicate bed numbers, and secondly maybe the types of wards or specialties are. I can't do either of these things..... there are 600 beds (i think) but numbers usually admitted reaches up to 1000. Admission to hospital certainly doesn't garantee you a bed or even a room inside the building. There were sometimes two babies in a cot
Mums would sleep between the cots on the floor or under the cots if two babies were sharing. You have to bring all of your own food, and linen. There were people everywhere. Just everywhere. Pieces of material where laid out on the concrete floor underneath some beds where more patients lay. The main block of wards had four levels, or which there were balcanies spread all along, each balcony is also a place that patients lie. I have no idea how the manage infection control. actually... they don't.

But whats astounding is that there are three other hospitals in town of the same size... i mean it is the capital of malawi, and probaly millions just in around lilongwe...But the things is, that on every street corner in town there are chipatala’s which are clinics that are also known as hospitals, people can have babies, minor surgery, short stay wards to receive all sorts of treatments.. so the three giant hospitals hardly even scratches the surface of the enormity of health care demand in this city. There are areas within Lilongwe that hold 100,000 people. and you would know it by their size or the infrastraucture/housing/development. Its just astounding.

I had a patient come in to the clinic today who have both clearly had strokes, and neither will have any opportunity for a CT or God forbid and MRI. There is one CT machine in Malawi, and that’s in Blantyre.

The enormity of the paediatric wards was just overwhelming. We went through as many wards as we could in about 40 minutes trying to find a patient to visit, we didn’t go to all of the wards, we were looking constantly and we didn’t find him, so that gives you some of an idea of how big it was… but with the population so paediatric dominant, I guess its no surprise. But with our two hospitals in ballarat…for a catchment area of the entire Grampians region... one closed down its paed ward, and the other sometimes only had 5 or 6 kids… I am just blown away. There would have been 400 or 500 hundred maybe, and that’s only at that hospital, and then there are soooo many more people in Malawi who would never see anything other than their own rural village in their entire life, let alone actually see a hospital in their lifetime.

We were passing a line to get into another section, and a lady stood holding her baby, vaguely staring into the distance, I have never felt such shock as I did when looking into her arms, the baby was clearly not alive anymore, I think Morgan knew i had seen, and kindly took my arm to help me move along, he didn't speak for about 5 minutes, just stuck by my side and lead me through the long hallway with wards off to each side overflowing with people, we walked silently for what seemed like forever. i didn't even know how i felt. the air was thick with noise, and odours of all sorts, i kinda wanted to cry, and kinda wanted to just get out of there and hide. but i also had so many beuatiful kids smiling at me, and mums greeting me with such exhuberance all the way along the corrider that i couldn't help but smile as well. i felt so many conflicting emotions. we then got trapped behind a big line of people and had to wait for some time to move past everyone to get outside. It was then that morgan turned to me and said.. "maybe she just didn't know what else to do" and he then took my arm again, and we pushed our pay outside, as he walked he just quietly prayed for the strangers in the corrider that had affected us both so deeply.

A working day

I know I have given very little update on my work here in Malawi, especially given that it occupies a large proportion of my time here. But I realised that the work is rather challenging and is taking a lot of my energy, so to sit down and type about work itself in my spare time has been a bit to much to handle in these early stages of settling in.......
But sit back and relax as a share with you a working day in the life of Tamara here in Malawi

Work starts at 7:30am, it’s already warm enough to open all the windows and put the fan on to prepare the room for the onslaught of heat and crazy kids. The communication room is one of the few that actually has a fan, so I’m pretty pleased about that!! The first hour sometimes includes meetings, sometimes admin or preparations but usually greetings to everyone checking you all had a good night, which is definitely an essential part of the day. From 8:00 we have different groups of children on each day from the special education classes at the primary school. At 8:30 the morning rehab program begins. Basically we collect children and their carers in a minibus, according to their Area (we don’t have suburbs here, people live in numbered areas, which have absolutely no order eg 7 is next to 19, which is next to 35 etc), they are encouraged to attend 2-3 times per week. We are not allowed to use any fancy toys or resources in therapy, as the whole aim is to teach them how to do their own therapy, therefore we can only utilize things they may have at home. This isn’t always possible, however we try our best to stick to this strategy. The day is divided into two therapy blocks of numerous half hour sessions that the children rotate between according to their needs. We have between 30-60 children attend each half day session (plus carers)

There are a variety of physio groups, OT groups and speech groups, ( I think there is a total of 19 different groups they can attend, but they are only able to attend 6 in a session) children are placed according to their functional ability not their diagnosis (which is often not known anyway)
Although to give you a summary, the majority of children have various multi-disabilities. There really aren’t any children here with minor issues. The mix of disabilities includes CP (as an overwhelming winner) muscular dystrophy, hydrocephalus, downs syndrome, unknown brain injuries, seizure disorders, severe hearing impairments, TB of the spine, rare genetic disorders, and acquired brain injuries. Many many children develop normally to ages such as 2 weeks to 2 years then at some point suffer from a variety of infections (largely cerebral malaria) resulting in persisting brain injuries.

It has been three years since a speechie has been at SOS and the staff who were there at the time, and received training directly from that speechie, were both away for the last 12 months studying in canada, so much of the good work, was undone. So I have had to start again in a lot of ways. Before I arrived they had one 30 minute communication group, and a 30 minute oral motor/eating drinking group. We now have 6 different groups, running in a half day session.

The day I arrived I was given a list of 55 children requiring speech intervention, the list has now just hit 240….. and is sure to continue growing. The rumour that I was the only speech therapist in the country of 12 million is definitely true!! I have not completed one formal assessment on anyone, and I don’t see that happening anytime soon, however we now successfully have a database of all the children, and the simplest assessment in the history of speech pathology…… How many words do they have? How do they tell you they want food? How well do they understand you? Describe their development compared to your other children. And that’s it. So although I feel like I have hardly progressed, we have nearly completed this questioning on all of the children, and grouped them all into the 6 groups according to their functioning level. So I think I’m getting somewhere.

Victor & Morgan are the two communication assistants who completed a one year course in Canada and arrived back in Malawi shortly after I arrived. So from a programme with no one focusing on the communication side of things, we now have a team of three, which is great. My role with them is to continue their training, supervise and support them to become independent, and they’re doing a fantastic job! Completely different personalities, styles, opinions & ideas, but both fantastic in there different ways

So the groups include speech sounds, communication for the hearing impaired, early language, socialization, AAC (picture boards & gesture stuff), oral motor, eating & drinking. On average we have between 2 and 12 attending each group, and there is no pattern, despite my desperate attempts to try and keep a bit of order… it just doesn’t happen. So planning for who is attending the group really is out the window, as there will always be different kids than you expect! Common occurances in our communication room – to many bodies crammed into one space, laughing, singing, crying, peeing on the floor and seizures.

Once the guys are a bit more independent in running the groups, I will have more time to do the assignment I came here to do, which involves lots of training of the other staff, developing resources, developing parent workshops, and connecting with other organizations to improve speech therapy in the region/country. Oh and next year in April SOS is opening another village in the south near Blantyre including a rehab program, so my job is to develop the speech services there also. Oh dear. How long am I here for again?

So the first session finishes at 11am, at which time we see individual clients for hearing assessments, stroke patients, three boys with autism, other complex children, or whoever has dropped into the centre for assessment.

Although I have tried to encourage the boys to keep a record of when they book patients in, this rarely happens, and even if they did, most people don’t really follow time or days very well so they could turn up at anytime.

I escape at about 12 back to my house where I rehydrate, eat some food and usually lie on the cool floor for about 30 mins until we start all over again at 1pm. Some days I’ll chat to my family as this is when they usually ring, some days I have visitors for lunch, if the water is out I’ll run home to collect more from the bore whole, or remove my clothes from the line so they don’t melt to the ground or some days I’ll stay at work and just chat with people.

So including the children attending the rehab program, children from special education classes, and individual assessments or therapy, between 100-150 people per day attend our rehab program, of which atleast half attend speech therapy, which is very likely to increase as more education and assessments are conducted.

So gone are the days when I used to think 15 patients was a busy day. And writing this now makes me realize why I’m often so exhausted of an afternoon!


Tuesday afternoons are the only exception to this rule, this is our meeting and or inservice afternoon. There are three terms in a year, and at the end of each term everyone writes a multidisciplinary report of the childs progress… this is often the only documentation that happens. Also at the end of a term workshops are run for two weeks. The workshop programme is sensational, we have a day for each therapy area, and the parents are required to attend for the whole day, they are very practical sessions, and highly valuable. We are currently in the middle of these now, as they are always run earlier in term three, because if they were run in mid December this would be in the middle of the rains starting, so attendance would be terrible, as the first few weeks of rains means everyone is home planting their crops.

After the workshops there are about two weeks of home visits, which is a time to deliver equipment, or check the status of people who havn’t attended in a long time.

The last hour of the day involves locking all of the toys & resources away, reporting any that are lost, things often walk!! Trying to document even a little of what has been done in the day or another meeting of some sort.

Then at 4:30 I stagger home. And never much later than that, as the guy who locks up the building pushes everyone out at about 5 minutes past finishing, so there is no overtime possible.

So that’s a rough outline of work. By western standards we are way understaffed and under resourced for the numbers and diversity we are seeing, but by Malawian standards and western standards combined, I think we have an absolutely amazing programme, which is servicing an extreme number of families, supporting them, empowering them and teaching them, and its sensational to be a part of it!!