Week 2: Lectures, timetables and plastic babies

After our first week of orientation, meetings, paperwork, and multiple trips to the NMC of Malawi to get registered, we were ready to meet our fellow students and get to work.

Week 2 saw us attending midwifery and reproductive health lectures with the third year students. In Malawi, the shortage of resources requires trainee nurses to learn a lot in a short time, meaning a 4 year degree course here covers nursing and midwifery – students need to learn a little about a lot, and fast! The students were amazed to discover that nursing and midwifery are separate degrees in Scotland. They asked us what would happen if we ever needed to deliver a baby…

When talking to students about their course, many of them mentioned “serving Malawi” and meeting the “needs of the nation”. There is a shortage of nurses here, and the health needs of the population are vast. As a result, Malawi needs more nurses who can handle any situation that arises, and do so without many of the resources that nurses in other countries consider mandatory.

The format of lectures and teaching style in Malawi reflects the volume of information needing to be absorbed, by the high number of students enrolled each year. The lectures we attended throughout the week were very direct and somewhat prescriptive. While the lecturer invited students to answer questions, there was none of the debate or back and forth that we’re used to back home. Lecturers are highly respected (or feared) by the students. Interaction between students and lecturers is formal, with ‘Sir’ and ‘Madam’ used for politeness. While we focus on developing problem solving skills, the approach here seems to follow more of a checklist approach. However, the knowledge and conduct of third years impressed us; they were well informed, asked pertinent questions of the lecturers, and presented some well researched seminars. This is even more impressive considering that all lectures are conducted in English, even though that is a second language for Malawians (Chichewa is usually the mother tongue).

The timetable looked pretty heavy going, with classes from 7:30am to 5pm Monday to Thursday, and an hour for lunch. Friday offered some respite with a 3pm finish. Daily 7.30am starts seemed unimaginable, but we managed it. Luckily, staying on campus meant we had a very easy commute. By the end of each day we were all exhausted.

Without fail, all week long, about three minutes into every lecture as the lecturer scanned the crowd, they’d spot the 5 ‘azungu’ amongst the students, and look visibly taken aback.  Even when we spread ourselves out amongst the other students to be a bit more sociable, we still didn’t stand much chance of blending in. Luckily everyone was very welcoming and after introductions and a few questions about our background, the lecture could continue.

A highlight of the week was attending a clinical simulation lab in the new cafeteria. Over 100 students, split into groups of 10, worked with Neo Natalie baby mannequins (filled with water to be more realistic) to practice deliveries. 

We learned about the Golden Minute after birth, what to do if a baby doesn’t cry right away, and how to perform suction. It was the first time any of us had ever delivered a plastic baby (or any baby, for that matter), and it was fun to work with the other students to perfect our technique. Knowing that it is highly unlikely we will ever need to do this in the future took the pressure off for us. Then we realised that the following week, on placement, some of the third years might actually be practicing on real live babies. Nothing like getting thrown in at the deep end to focus the mind, I suppose.

At the end of the week, we were happy to have made some new friends and had a glimpse of nursing education in Malawi. We were also very excited about starting clinicals the following Monday with the first year students, conducting health checks in local primary schools. And at least now we have a better idea of what we need to do, should we ever have to deliver a baby...

Red dust

As we flew over Malawi and came in to land, way back at the beginning of this adventure, we caught glimpses of long, straight, dusty red roads, stretching out across the landscape. It looked exactly how we had imagined Africa might look.

We’re in the colder, dry season now. We haven’t seen rain since we arrived. This is the Malawian winter. Temperatures reach the mid 20’s during the day, but plummet to 5 or 6 degrees celsius at night. That probably wouldn’t feel cold to us back home, but the contrast is tough. We layer up before bedtime, and hope that the samovar downstairs is hot enough for tea. Socks, leggings, tshirt, a hoody (or 2 if you’re Jen), then bundle up in blankets before carefully draping our mosquito nets around ourselves. We’re told that it’s not a bad time of year for mosquitoes but we’ve all had a few bites so we’re playing it safe and trying not to miss a dose of doxycycline (or malarone).

The daily doxy tablets makes us photosensitive, so we’re extra diligent about sunblock. A sunburn would just make us stand out even more. At first we thought we were getting an amazing tan, but disappointingly it was just the dust. It swirls up in clouds, and covers everything with rust coloured grit. When we wash our clothes (by hand, in buckets, with water from the samovar…) it turns the water red. If we don’t sweep our room every other day or so, it becomes impossible to get dressed without our socks and uniforms being painted with terracotta coloured patches. The students here wear bright white uniforms, but when they go out into the community they add a bright green apron (for the girls) or a 'duster' (a bit like a lab coat, for the guys). But we still couldn't figure out how they managed to stay looking clean all day.

Most ladies in Malawi wear a bright chitenge over their clothes to combat the dust. It’s 2 metres of wax printed cotton and it has many many uses; either as a skirt, or to hold a baby to your back, or to tie things up in a bundle. We’ve been getting lessons from the students on how to wear them, and we’ll definitely be bringing a few back to Glasgow. Even if the red dust isn’t such a problem back home.

 

Nsima, nsomba, nyama, nyemba: food!

A milestone in our first week here (which seems a long time ago now) was buying bowls so we could get food at the canteen with the other students. 

Lunch and dinner are served on campus every day, 12-1 and 5-6, prompt.  It costs 750 kwacha (MKW750, around £1), or MWK500 (about 75p, ish) for the veggie option.  This was our first taste of traditional Malawian grub.

The menu’s familiarity ensures you know what you’re getting. The students were all excited for us to try nsima (a dense maize flour porridge – think polenta or American grits but more finely ground and cooked for longer).  A standard portion consists of 4 patties (or bullets) known as a cross. We got a few funny looks as we dug in with our camping sporks... it's more common to use your hand to pinch the nsima into bitesize pieces with a dab of sauce and some of the relish (stewed veggies)

Nsima is the staple of the Malawian diet, the alternative being rice. Either option is accompanied by a choice of nkhuku (chicken), nyama (meat, usually beef or possibly lamb), nsomba (fish) or nyemba (kidney beans) for the vegetarians. There's also stewed greens (pumpkin or bean leaves), a tomato based sauce, and maybe aubergine or okra if you’re lucky. Some days you can also get a boiled egg in a spicy sauce. They're really good. The portions are also so huge that at first we thought maybe the students made do with only one big meal per day. They tell us that they usually have lunch and dinner, but breakfast is usually just a cup of tea (with milk powder and plenty of sugar).

We have talked about Malawi time already, which means that most things seem to involve at least half an hour or more of waiting around. Meals are the one exception to this and if you’re not fast you’re last. Some days we’ve rolled up just before one to find only empty pots and the apologetic faces of the ladies who cook and transport the food to campus.

There are other places to eat in town, for when we’ve reached our rice limit, but these are all much more expensive and require a tuktuk journey. There are also little roadside stands where you can get freshly cooked chips (mbatata iriisi - Irish potatoes, or mbatata - sweet potato). Luckily, most days we're too tired to be picky, and rice definitely does a good job of filling you up. 

Salima trip.

Wearing the KCN colours with pride

On my first weekend in Malawi, Kamuzu College of Nursing had organised a football match with Salima Technical College, situated on the shores of Lake Malawi.  Recognising the importance of integrating into the KCN, I (Michael) agreed to go on a road trip with a bus full of rowdy boys (and girls) to play football.  It also sounded like a good laugh.

We assembled at 8am on board the ‘Mighty Torino’, KCN’s bus and flagship mode of transport and set off through the beautiful Malawi landscape.  

We stopped off in Salima itself to buy snacks and supplies and I had my first glimpse of rural life.  Upon the bus’s arrival, locals carrying armfuls of fruit and raffia headgear with a fervour that belied their desperation to capitalise on a much needed source of income, including one forlorn looking little boy who came up to me and tried to sell me a ragged page from an exercise book scrawled with various letters and numbers.  Unsure how to react I and not wanting to show myself out as being an easy mark I mumbled some apologies and walked on, but in retrospect I wish I’d given him a few Kwacha.

Kondwan, myself and Godwell before the off.

We got stocked up then headed on to the campus at a place called Senga Bay which resembles a desert island, 100m from the shore of Lake Malawi, with fresh water breakers rolling in to the beach and the water a balmy temperature (or balmy enough for this Scotsman basking in Malawian ‘Winter’). 

The football pitch at Senga Bay

We gathered for the football match and I was assigned position of Right Back, then I remembered I’d not played a proper game of football in at least 5 years.  After a few simple passes left me wrong footed and sprinting after the ball, my team mates spared my blushes and kept me out of the play.  I knew things weren’t improving when people were saying if I was tired I could come off, and eventually I got the order that I was being substituted for someone younger and more agile.  I’d lasted about 20 minutes.  Ah well, the game ended up a respectable 2-2 draw against strong opponents and no-one seemed to hold a grudge.  Stuart, the KCN director of Sports summary was rather positive about my performance (‘quite fast but with poor co-ordination’).

The post-match bath was a dip in Lake Malawi then we had a stroll along the beach for a traditional meal of nsima, fish and beans, in an honest-to-goodness proper shack, where I was greeted with gasps of amazement, I don’t think they get many of my sort around here.  The students of both colleges were incredibly friendly and I got know some great people within my first week of being here.  

Result!

Getting here: the never ending journey

We left Glasgow a week ago, and have spent the past few days settling in on campus. We still haven't got logins for using the internet on our laptops, but students have helped us to connect to WiFi with our phones. So we will be playing catch up with stories on the blog for a while. Let's start at the beginning...

We've been planning this trip for so long, and have had to negotiate quite a few obstacles, but it still didn't quite feel real as we waved goodbye to our loved ones at the airport.

Our journey would take 22 hours, via London, then Johannesburg and eventually to Lilongwe. As the plane took off from Glasgow we all breathed a sigh of relief as we realised Caley to Malawi was actually happening!

A miscalculation in London about how much time we had before boarding our plane to Johannesburg, led to a panicked 15 minute sprint across the terminal. The tannoys were announcing final calls and doors closing. As we tumbled down the tunnel to board the plane, the air steward kidded on that he was locking the door and we'd missed our flight. But all the ground crew fell about laughing at the sight of our faces, and we were able to settle in for our 11 hour journey.

We flew over Europe and then the Sahara Desert, down to South Africa before changing planes and doubling back up to "the warm heart of Africa".

Feeling a bit sleep deprived, but still just as amazed to be where we were, we waited to board our final flight.

On the flight from SA to Malawi, I met a Malawian nurse called Jacinta who was travelling back home from Boston where she's doing her Masters. She teaches in Lilongwe, at the sister college to Kamuzu College of Nursing, and was very excited for us. She reassured me that we would learn a lot while we are here, and said she would check in on us.

At the airport, we queued up and were waved through security, with a vague instruction to present at the visa office within 30 days. Then we walked through to the arrivals area, a jostling sea of taxi drivers all competing for jobs. We split between 2 taxis, to have enough space for all 6 of us and our luggage. And then we got our first proper glimpse of the place which will be our home for the next few months.

Next up... A tour of campus, and our first taste of nsima - the national food staple of Malawi.

Malawi time

We are now officially registered with the Nursing and Midwifery Council (NMC) of Malawi! Malawi time takes some getting used to, and the process took us 3 days (with multiple trips to banks, letters from our uni, and forms signed by our lecturer Alan as well as the Dean here at Kamuzu College of Nursing (KCN) ). Things move slowly here, but everything seems to get done eventually.

On Tuesday, we were told we would need to pay $100 to register with the NMC Malawi. Unfortunately, on Monday we changed all our dollars into kwacha, so we had to head back to the bank. ATMs only allow you to withdraw 40000 kwacha at a time (about £57) but we needed to change 48500 kwacha. So, two ATM transactions, two charges from the bank, then the charge to change it into dollars next door at the bureau de change (they couldn't give us foreign currency directly using Visa). Then, when we finally got to the cash office at the NMC, we were told that they no longer accepted dollars, as it had led to corruption in the past. So we were asked to pay 15000 kwacha instead (much better deal...). By this point, I didn't have enough kwacha left (it was beginning to feel a bit like a chuckle brothers episode) so our escort from the admin department and the uni bus driver lent me 3000 until we could get back to a bank.

We also had to pass a surprise interview with the NMC Director of Educational Exchanges, to discuss our previous theoretical and practical experience, and our objectives for this placement, to make sure they could provide enough opportunities for learning here. Luckily, we aced it. And next week we join the KCN third year cohort!

This week we have also tried nsima (maize flour porridge), bought bowls so we can use the student canteen on campus, learned how to greet people and say thank you in chichewa, met some students, braved the showers (a story for another day), and visited the Lilongwe wildlife centre next door to the campus (where we came face to face with a wild boar on the trail! And also saw crocodiles, monkeys, baboons, a duiker and a serval cat).

Apparently classes start at 7.30am here. Some of us (ahem) struggle to make it in on time for 9am lectures at GCU so we'll need to make sure we don't show ourselves up. It's not as easy for us to sneak into the lecture anonymously here. Early night on Sunday I think.

This time next week...

Arms have been jagged, flights are booked, Memos of Understanding have been emailed across thousands of miles and I'm now well versed in the medicinal options for preventing the contraction of Malaria and how to fly to Southern Africa avoiding countries with a risk of Yellow fever (via London and Jo'burg) -6 days to go and it's actually starting to happen!

When we started planning this almost a year ago we knew we'd have to do some fundraising and we decided on a Kickstarter type project where our sponsors get various little rewards in exchange for support.  We've had some extremely generous donations already, but why let them hog all the glory- there's still time to donate today!

Seriously though, today is the last day and your last chance to help us with this project, if you can spare a few pounds, dollars, pesos or yen that would be greatly appreciated, please do so using PayPal via the link below:

https://hubbub.net/p/caleytomalawi/

Many thanks,

Caley to Malawi Team