The Lot of Malawian Village Women

         

Me and Kuyvina Enjoying a Quiet Moment

          This past weekend was so hot that the prolonged black-out did not help matter.  The only time it is a little tolerable is early in the morning and in the evening.  Kuyvina has learned that there is an exciting world outside for her to explore but when she lives with a bunch of women, her fate is sealed by one of the expats who has appointed herself as her caretaker and who insists on her getting a flea collar before she could be free. Like most of the things we wish for here they do not come easily and she has waited for almost a month and a collar is still not in sight. And so she could only be held while I sit or walk with her outside in the early mornings and evenings.  Some mornings she is so frustrated that she gives out a heart-breaking mournful meow and then proceeds to scramble up the wire netting of the front and the back porches hanging on like a giant gecko. On one particularly scorching afternoon after playing hide and seek with my hat, she took a cat nap in the coolest place she could find, curled up in the small sink in the dining room.

 

Kuyvina Playing with My Hat

          

Kuyvina Curled up in the  Sink, Pink Tongue Sticking out

          This morning dark thick rain clouds gathered in the sky.  This had happened once before but the clouds soon were blown away.  While I was getting ready to go running, Kuyvina had forced her way outside, big drops of rain began to fall, she looked heavenward, bewildered.  The pitter patter on the roof became louder, heaven opened up and a heavy downpour descended on us.  This was highly unusual for this time of the year, the wind picked up and the temperature became cool enough I had to wear a cardigan to work.

           
           I was really looking forward to going to Lulwe in the mountain today.  The rain flooded the trenches on the sides of the dirt road forming gushing streams.  Its pattering on the roof drowned out conversations.

               

           Before we arrived at Lulwe, a man who came in with a couple of months of knee pain was sent by the medical assistant to have an HIV test.  When he returned he came in with his male relative, the medical assistant shooed him away and asked to have his wife sent in.  He tested positive for HIV and she was advised to get tested and she too was positive.  They had three children, the middle one died and the others were ages two and eight and had never been tested.  The couple was sent off for counseling.

           A woman came in with her sixteen-months-old child, her breasts hanging out of the V of her blouse and at once the medical assistant asked her to cover herself.  She replied that her child was fussy and she had to breastfeed him.  She had seven children, one died.  Having nursed so many children her breasts looked withered and limp, seemingly sucked dry by the child.  She was tested positive for HIV during her antenatal visit but refused to start ARVs.  Her husband had not been tested. She feared that she would be sent home if her husband learned that she was taking ARVs.  Since there was no actual result of her HIV test she was retested and both she and her baby were positive.  Over the last few months the baby’s height and weight had fallen off the growth chart.

            Both Lulwe and Chididi are high up in the hard-to-reach mountains but Lulwe being close to Mozambique where the men go for long periods to work and bring back HIV to their spouses.  A lot more women in Lulwe tested positive for HIV than those in Chididi.  Some men from Chididi go to cut sugar canes in Nchalo and stay away from home for a long period and they too bring home HIV infection.

           The tradition of men having to abstain from sex when their wives are six months pregnant till six months post-partum also leads to their seeking sex elsewhere.  The practice of kupitakufa or cleansing has been a reason for the spreading of HIV.  When a woman’s husband dies, any one of her brother-in-laws could take her as a wife.  Because there is a death in the family she has to be cleansed by having unsafe sex with a man whom the family has to pay in cash or cows to perform the cleansing before she would be accepted back to her family.  She is sent home when there is no one to take her as a wife and has to leave all her children to her in-laws.  She has no rights to any one of them.  Polygamy helps in the spread of HIV.  Most men refuse to get themselves tested even when their wives are on HIV treatment.

            Agnes being an educated woman reprimanded her woman patients for not covering up.  She was not very tall but she wore a slinky flamenco-like dress that made her look slim and lanky; she looked very distinctive and attractive with her high cheekbones and her corn rows on her head tapered to form a small bun at the top of her head.  When asked if she would share her husband with other women, she smiled shyly and said no way.  She knew of a man with six wives and thirty-five children and the women raised the children.

          Village women often multitask; breastfeeding their babies while carrying a bundle on their head on their way to the market doing the business of selling and buying.  They till the land, chop wood, pump water with a baby on their backs. I saw a woman on one of my morning runs carrying a bundle of firewood to the market to sell while carrying her baby on a sling with two young children in tow, one of whom carrying a plastic bag which probably contained their food.  Women may work the land but the men own the property.  It is indeed a harsh life for these village women with little education, nebulous social standing and insecure financial status. 

         

          After helping a young woman deliver her baby, a middle-aged mid-wife in Sankulani threw her hands up in the air and remarked exasperatingly, “These village women are not interested in education, all they want to do is to get married and have many babies.”

        

Masenjere

Mesengere Health Center

Cracks on the Walls of the Maternity Unit

          The big cracks in the walls of the building that houses the maternity unit are the first thing that catches one’s eyes when one gets to Masenjere Health Center.  Inside, the antenatal and labor and delivery rooms are cordoned off as unsafe and the postnatal ward now is antenatal and labor and delivery as well.  The ominous cracks in the walls and floors which at some places are buckled look like an earthquake has struck.  Given the extent and the proximity of the cracks to the postnatal unit, one wonders why it is not condemned. I was told that the plight of Masenjere had been widely publicized in the news in the past and I have seen pictures of the cracked walls posted in some other health centers. 

          

ART Clinic of Masenjere

          The ART Clinic is in the second building and unlike Sankhulani, it is spacious.  Unfortunately it is filled with trash piling up on the floor and on top of MSF-donated exam table. MSF has also recently delivered a bookcase, table and chairs.  Apparently my team visited it last month and addressed the trash issue and took it upon themselves to clean it and there seems to be no impact.  The TB Clinic is not much better. It is covered with so much dust that it looks as though it has not been dusted or cleaned in a long while.  The other issue that disconcerts me is the proximity of the TB Clinic to the HIV Clinic, perhaps they are run on separate days. 

          A sixteen-year-old girl came with her guardian yesterday.  Her parents died when she was a baby and since then she continued on HIV medications till three months ago, although she and her guardian did not know that she had HIV infection.  This was never disclosed to her. I find it hard to believe that a sixteen-year-old would continue to take medications without asking what they are for. There are disclosure procedures formulated by the HIV/AIDs Unit and only trained counselors are allowed to do the disclosure which is done in stages. This patient was retested and confirmed positive yesterday and learned for the first time that she was HIV positive; she had been so distraught that she refused to resume her medications.

            As we left the East Bank I felt like we are swimming upstream against a whole slew of obstacles that seem quite insurmountable except perhaps the simple problem with outfitting the ART Clinic in Sankhulani, but even that I am holding my breath to see if it will be easily and readily accomplished.  With the visit of Masenjere, I have now visited all fourteen health centers at least once since I arrived.  The worst health care center in terms of physical conditions is Masenjere and a close second is Makhanga, the bat infested center.

            In the stretch between Nchalo and Bangula, there seems to be more aggressive tree chopping and the trees are barren or if there are leaves they appear shriveled.  The land is dry and dusty and without much tree coverings it appears desolate and baked, the landscape resembles the northern part of South Sudan.  The aggressive deforestation through random cutting as well as burning also seen in the mountainous areas on the way to Thyolo, not only makes the mountains look bare but probably is not too kind to the environment.  One could only hope that some programs of replanting and education will be introduced to slow down this devastating process. 

Have a Sankhulani

Jacaranda in Bloom

          Over the weekend I stayed in Limbe, next to Blantyre and on Monday I traveled south to the East Bank to meet my team who traveled north.  Blantyre is abloom with lovely Jacaranda flowers.  Unlike the last time we were at the East Bank this time we traveled for an additional 18 km on a very bumpy road up the mountains to Therkerani in Thyolo to stay in a MSF guesthouse.  There is no running water and the strong woman housekeeper fetches water starting around four in the morning. I have a mortal fear of latrine but the latrine here is surprisingly free of odor.

            In the morning I ran up to the peak, the morning sun came up around five much earlier than in Nsanje.  But before then around three thirty in the wee hours of the morning till five, a persistent and annoying announcement for passengers to Limbe designed to keep everyone awake kept me up.  By then it was so bright that any hope of dozing off to sleep evaporated.  Already many of the villagers were up and about, women fetching water from the borehole, men firing up their tower of bricks…

Women Carrying Water from the Borehole

         

Men Firing Bricks

           Sankhulani has an ornate globe as its water tank sitting prominently on top of its building.  Ironically this health center has functioned without water for three years.  Only part of the solar panels works; there is light in the maternity unit but the solar panel that works the engine that powers the pump for the water does not.  It has not been fixed for that many years.  If a woman comes to labor and delivery, her guardian will be asked to fetch water from the borehole.             At one end of the maternity unit, there was a distinct odor of bat guano.

 
                                                                               

Sankhulani Health Center

          A bed was prominently placed in the room for the Antiretroviral Treatment Clinic (ART), on it were strewn with patients’ files, a medicine cabinet, a non-working sink and two chairs donated by GOAL, an NGO in Ireland; a very spartan set-up.  The medical assistant saw patients in this room.  MSF donated an exam bed which languishes in the Antenatal Clinic because there is not enough space for it. Yet this clinic was deemed in the graduation phase of the site assessment of the mentorship program in the last quarter.  How on earth did that happen?  Sankhulani means choice but the healthcare personnel running this clinic have not much choice.

                                                                           

ART Clinic

          Part of my team was visiting Makhanga, the bat infested healthcare center.  I visited it last month and at that time they agreed to switch ART room for the more spacious HIV testing room.  Unfortunately no progress has been made; it has been a contest between the Ministry of Health maintenance and our logistics to see who blinked first while I suggested that MSF should just go ahead and move the shelves as requested before anyone had time to change their minds.  Changed their minds they did and now it seems that the higher-ups in the Ministry of Health are involved and are against the switch, arguing that HIV testing also needs a big room.  MSF loves to end a meeting by asking for the Way Forward, this feels like the Way Backwards as this problem was listed a priority to be solved in the annual report of 2012 and now nine months later it remains unresolved.

            A small woman with a baby swaddled in a tchenje sat bolt upright waiting patiently to be seen.  It appeared that she just had her fourth baby at home, not sure if she was assisted by an attendant. Despite that she did not look tired. At the Antenatal Clinic all mothers-to-be are taught to have a new razor and a clean thread handy at home in the case of home delivery. The women here not only have to earn a living the hard way but also to be able to deliver their own babies.  Sankhulani has a population of 7700, close to 50% are under 15 years of age and about 18% below 5 years, villages full of very young people.

            Earnest came to talk to me while we were waiting for our transport. He volunteers at the center two to three times a week as a HIV tester and counselor and helps his wife at the farm two days a week.  His wife as he puts it is a farmer working six days a week in the field.  He married when he was twenty-two and his wife was seventeen; I forgot to ask him whether he had to pay a dowry.  She was taken out of standard three to work as a domestic help, a common practice for young girls to end their schooling.  He went to school till Form Four but failed his Malawian Certificate of Education (MCE) and did not have money to repeat the two years to retake his exam. They have four children, the youngest is two months old and he said that “his work” is done.  They are considering family planning and surprisingly he said he is considering kuseka (vasectomy) as he thinks his wife should not be the one to undergo any procedure.  He is somewhat forward thinking although his wife continues to be the major bread winner of the family.

            The medical assistant runs the clinic this week as the two nurses are away, one on leave the other is taking a training course in “Long-lasting methods for family planning”.  The HIV counselor spoke to Earnest that they should be prepared to provide basic medical care for the patients who do come despite the absence of the other staff.   

Cows Crossing the Railway Tracks

          In the afternoon we crossed four railway tracks to the Ruo River, one of which is still working; a train runs from Limbe to Makhanga once a week. In the distance a herd of cattle crossed the tracks probably returning from the Ruo after a drink. 

The Boys at the Ruo River

          The Ruo River looks deceptively tame now with several rivulets divided by rocks and elephant grass but during the rainy season it covers all the rocks and forms a big roaring river.  Children, all boys, romped in the water to get relief from the heat. 

          During the night I tossed and turned mulling over the problem of the ART Clinic in Sanhkulani.  In the end I decided to forward a request to build a single shelf for the files, replace the bed with the exam table; donate a small table for patient’s consultation and a bucket with a spigot for hand washing. Voila you have a functional clinic! I shall wait and see how long this would take to happen.

                                                                      

Zomba Plateau

          Erin and I headed towards Zomba Plateau this weekend.  I met her while hiking Mulange. Parts of the road to Zomba are under construction and our driver Hassan took a number of detours over rocky and bumpy dirt roads.  We passed the notorious Zomba Central Prison which is the largest prison in Malawi.  It is meant to be for about 800 prisoners but it is so overcrowded that it is housing three times the number of inmates with prisoners packed like sardines in their sleeping arrangement. The prevalence of HIV and TB is not known but is believed to be high.

            We did not stop at Zomba but instead drove up to the plateau.  The day was hot and hazy. As we turned into the road that led up to the slope of the plareau, a sign said, "Welcome to Casa Blanca". Many women, girls and some boys were carrying heavy bundles of firewood from the plateau to the town to sell.  Because of the distance they had to travel a piece of wood could fetch 50 to 100 kwacha (15 to 30 cents).  Again we rarely saw any man doing this kind of heavy work. Hassan said it is cultural. Most of the heavy work is designated for women including tilling the land and if a man is seen doing the chores he is not considered manly enough.  That is not to say that there are men who do till the land and chip boulders.  If a man earns any kwacha, most of it goes to drinks not to the family, unlike the women who think of feeding her family.  The boys we saw carrying the wood bundles are selling them for their own spending.  As we drove higher we saw men selling wild berries: strawberries, blackberries, mulberries, gooseberries, raspberries and passion fruits.  They were very sweet and tasty.  Being Muzungus, we were charged Muzungu prices.

Carrying Wood down from Zomba Plateau

Tasty and Colorful Berries

          We asked if a woman sells the wood at the market, who takes care of her children? Hassan said the older children or the grandmother if the children are young.  But I have seen women carrying baby on their back with a bundle of goods to sell atop their head. Erin thought the women here need “women’s lib” and again we asked why they even bother to get married, Hassan answered with a hearty laugh, “They want what the men can work at night.” And after a pause he chuckled, “They don’t know that they can have it any time of the day.”

I said, “They work too hard during the day.”

          Ku Chawe Hotel, a posh hotel sits at the very top of the plateau. The plateau is several kilometers  across, windy and cool. Queen Elizabeth and Emperor Haile Selassie came to Zomba Plateau by helicopters and both had viewpoints named after them, but the best one yet was an unnamed viewpoint that Hassan took us to, too rocky for a helicopter landing.  The day was hazy mostly from the burning of the mountains so we could not see too clearly but we imagine Mulange in the indistinct distance.

The Rocky Viewpoint

Sorgin

          At Grand Ward Rounds today they discussed a tragic story of a 45 year-old gravida 9 and para 7 woman from Mozambque who used a local herb that acted like Pitocin to induce labor.  When she did not progress she consulted an “African Doctor” who could not manage her and she went to a local healthcare center which was unable to help her.  She crossed the border to Tengani Health Center in Malawi, by then she was bleeding heavily.  She was quickly transferred to Nsanje District Hospital where she was found to have suffered rupture of her uterus.  During surgery, the baby girl was stillborn and there was an anterior uterine rupture.  The rupture resulted in severely torn tissues and the surgeon was unable to repair the uterus, a hysterectomy was performed.  She bled heavily and unfortunately there was no blood in the blood bank. She was described as pale and in shock and stopped producing urine but was still conscious.  The last we heard was she was transferred to Queen Elizabeth’s Hospital in Thyolo about four hours away.  A number of factors resulted in her predisposition to uterine rupture, multiparity, prolonged labor, cephalopelvic disproportion…

            There is a severe shortage of blood in Nsanje.  A few nights ago a woman presented with severe anemia with hemoglobin of 2.7gm/dl.  Her relatives were asked to donate blood, one of them had HIV, malaria and syphilis infections and a second had malaria.  The clinician chose to transfuse her with the malarial blood after the patient received her dose of quinine.

Sorgin Health Center

          Sorgin is at least 50 km away from Nsanje proper, a health center which was built in 1999 has a set-up exactly like Tegani or Mbenje.  It is however a lot cleaner and the structure of the building is sound.  The woman who cleans the maternity unit told me that they have run out of soap, chlorine or any kind of cleaning agents.  Their sterilizer is broken and she sterilizes the instruments outside with a wood fire for two hours. A baby was just born not too long ago. Outside the unit a baby goat was sucking on its mother’s teat with a violent jerking motion. By lunch time when the heat was getting fierce the mother goat was lying in the shade while the baby goat gamboled on the dry grass. 

A Make-Shift Sterilizer

A Brand New Baby

          The ART Clinic was crowded with the registration clerk and the nurse attending to the patients in the same room.  The clerk spread the charts all over the table making it difficult for the clinician to function.  We suggested that he should register the patients outside this room to enable the medical officer or the nurse to have more space to see the patient. As always invariably one or two patients would present with signs and symptoms for tuberculosis in one of these clinics.

            On our way back we checked on the progress on the bridge at Mtaya Moyo, more rocks were packed on the foundation.  The locals call the river here Mtaya Moyo or lose one’s life because during the floods the boats are often overturned and many of the passengers are drowned.

The Bridge at Mtaya Moyo

Chididi

          This morning I spotted the mother pig with her ten piglets which had grown three times as big since I last saw them. A little girl ran along with me for almost half a mile coughing part of the way.  The sun, a glowing red ball, hovered over the roof tops promising to bring us a searing hot day today.

A couple of kilometers from Nsanje District Hospital on the M1 Highway is a sign pointing in the direction to Chididi.  It is one of the dirt roads I often run on and once ran as far as the top of a hill.  But Chididi is 14 km from the tarmac road high up on the slope of the mountains miles from where I ran to and could be reached after driving over many stretches of winding, rocky, gully-filled roads.  It is even harder to get to than Lulwe and Mozambique again looms close by.  The slopes showed ravages of the fires set randomly, charred and scorched grass, bushes and lower branches of tall trees and clumped of ashes here and there.

Chididi Health Center

          Chididi Health Center is run by the African Evangelical Church and the patients pay a fee to be seen.  It is right across from a primary school where a group of Jacaranda trees showed off their lovely purple small trumpet flowers. A large crowd of children milled around us.  The health center has a cluster of three buildings: OPD, dispensary and a public health office in one building, the male ward, the HIV Clinic and testing center in another and the last one is the ubiquitous maternity unit, the postnatal unit also serves as a female ward.  A large group of women congregated on the veranda while a health worker was giving a talk. 

School children in Chididi

Jacaranda

          Today was not a HIV clinic day so we looked at the Early Infant Diagnosis (EID) register and many of the mothers and infants failed to show because they were from Mozambique.  Happily many of the infants were tested negative for HIV by PCR-DNA thanks to the Prevention of Mother to Child Transmission Program (PMTCT) although many of the results were not forthcoming despite months and a few of them after a year of the samples being submitted.

          On a bench I found a youngster curled up sick and feverish, he turned out to have malaria.  He was left there by his father who went to fetch his medicines.  Fortuitously because of our inquiry we found out that the dispenser had given the father an adult dose of malaria medications thinking mistakenly that the father was the patient. 

A School Boy with Malaria

          The HIV testing center ran out of testing kits.  I was told that I could get signal at a certain point up the hill as I tried to make a call to have the next team coming up to Chididi in the afternoon to bring some kits.  Up there a man was making a call on his cell phone and he relinquished his spot for me.  I never did get a signal, he had Airtel and I had TNM.

On our way down a steep road, a couple struggled to control a bundle of firewood loaded on a bicycle; the man holding the handle and bundle while the woman pulled the bike to prevent it from tumbling down the slope.  Mchacha, the nurse traveling with me commented that when they reached home, the man would go to rest or take a nap while the woman would go to fetch water, cook him a meal and if she had time, sell the firewood to get some money for food. A woman’s work is indeed never done but some of the men’s work here is not even from sun to sun  like in the quotation, it is whatever they please to do or not to do.  The responsibilities seem to rest squarely on the women’s shoulders.

I asked her how she was sure that would happen, she replied,” I live in a village, my father was like that and many men are still like that.”

“Why would the women want to get married then?”

“They want a partner.”

There is a bright ray of hope here; Mchacha and James the driver try to have an equal partnership with their spouses.

It is hard for me to imagine walking the many kilometers to the Boma with heavy loads to sell and then to lug the bundle of food up the steep roads for hours to feed the family, repeating this many times a week; the sheer physical labor in this heat would defeat even the fittest.

          As the heat builds up in Nsanje, black-outs are becoming more and more common, so no respite from the heat using either fan or air-conditioning.  This afternoon Peter in our office was lamenting the fact that the crocodiles were not willing to share the Shire River with us humans. I bet the crocodiles with their crocodiles’ tears welling up in their eyes would simply reply, “Oh, cry me a river!”

Nsanje District Hospital

Nsanje District Hospital

       

          My office is in the Nsanje District Hospital (NDH) with the mentors whom I supervise.  Here there is no WI-FI and I have to wind my way for about ten minutes through the backyards of villagers’ homes running into guinea fowls, chickens, goats and dogs back and forth to the MSF office to use the internet to check my work e-mail which seems to inundate my mail box all the time; or I could call for the land cruiser to give me a ride but I prefer to walk. The various health facilities that I visit regularly have no access to internet either.

            There are daily “Handover Rounds” or morning reports at 7:30 in the morning except on Wednesday when they have “Grand Ward Round” when a group of senior clinical officers, medical officers, nurses and students, about forty to fifty of them go around different wards to round on a few cases for diagnostic and management issues.  I have started to come to these rounds and when the District Health Officer (DHO) is in town and attends the round becomes interminable.  I often have difficulty piecing the story together because the presenters tend to speak softly and fast and oftentimes the same presentation is peppered with both Chichewa and English interchangeably.

            The Grand Ward Round of an entourage of forty to fifty people is too big for it to be an effective teaching forum.  If one were out in the periphery of the circle, one would be out of luck hearing the whole presentation.  Be that as it may, I have attended three of them so far and saw a few interesting patients that I would not see in US.  A 30-year-old man was bitten in the left cheek by an adder snake which I was told was a poisonous snake.  There was no anti-venom.  His face was bloated like a big balloon, eyes swollen shut, lips so fat that they were everted and he had trouble breathing.  The difficult decision here was whether they should intubate him with the only ventilator in the hospital in the operating theatre thus no emergency operations could be performed or cross their fingers and treat him with dexamethasone.  The latter was chosen and I heard that he did alright overnight. In the pediatric ward there was a youngster who presented with seizure and he was thought to have cerebral malaria.  A young woman who tried to kill herself with organophosphate was recovering.  The x-ray machine did not work when a young man who stabbed himself in the chest was treated for a hemopneumothorax.  A twelve-year-old girl who looked like an eight-year-old had a spleen so big that one could see it through the thin wall of her enlarged belly. She had malaria and was severely malnourished and tested positive for HIV. If she were infected vertically she had survived all those years with no treatment. A middle-aged woman presented with a chronic back pain, likely from Pott’s disease. There were other cases that would benefit from CT/MRI but NDH just has an x-ray machine and ultrasound. Because of MSF’s presence the lab can do CD 4 counts and viral load.  Cryptococcal antigen has yet to be brought here, Indian ink is still the way to go to diagnose cryptococcal meningitis. 

MSF collaborates with Nsanje

          I am cut off from any current happenings in the world except what is being delivered to my e-mail: the conflict in Congo, occasional news about the Syrian War but frequent update of Red Sox’s standing in the AL East. I am glad they are ahead of the Yankees and if all the stars are aligned correctly perhaps heading for the play-offs. 

Mean Kuyvina Rooting for the Red Sox, Yankees Beware

Kalemba and the Bridge over Troubled Waters

Kalemba Health Cebter

          Kalemba is about 46 km north of Nsanje, it is a Catholic community hospital and like Trinity it is better maintained than the government health centers although it does have some areas that do need some tender loving care.  The wards are scattered about in the compound at some distance from each other.  As a hospital however it does not provide many laboratory investigations other than malaria paracheck, hemoglobin and urinalysis.  The ART lab does draw blood for viral load and this is then sent to Nsanje District Hospital. Viral load has just being made available in a few health care centers and Kalemba is one of the most active centers to take advantage of it.

            The waiting area of the ART Clinic is in a narrow corridor and the clerk who checks them in uses an old bed for his desk, then they are sent to the nurse and medical officer.  The nurse mainly sees patients who are asymptomatic and counsels them on medication adherence.  This being a Catholic hospital there is no family planning but she could refer them to other facilities, however most women have to get their husbands’ approval.

            A woman carrying a two-month-old baby on her back when asked if her husband had been tested for HIV, she replied that he was positive but that he left her (she was the second wife) when she was a month pregnant and three children and also his first wife and five children to have a third wife.  Now she survived by tilling the land and selling what she grew.  She related all this without much emotion. The nurse’s reaction was, “Men are cruel.”

            On our way home the driver took a short detour in Bangula to look at the “wash-away “of the Shire River.  The fast flowing Ruo River fed its water to the slow-flowing Shire, overwhelming it and creating a run-off from the Shire and destroying a bridge that took vehicles to the East Bank, at least that was what I was told.  This has been a problem for sixteen years. A trip to the East Bank that used to take a couple of hours now necessitates a detour to Chikwawa and a five hour travel.  Apparently the government has now started to rebuild a bridge.  We talked to the engineer who told us that they hope to have the bridge done by December before the rain comes.  They were filling up the river with rocks and earth at the narrowest part of the river from both sides of the banks before building the bridge.  I just wonder if this would create a bottle neck for the swift water to flow and if so the bridge would be washed away again. This part of the river is called Mtaya Moyo (lose one’s life)

          The currents are swift here, men with big muscles maneuvered wooden boats loaded to the hilt, the sterns were almost level with the water while passengers were busy bailing water out of the boats crossing this narrow section of the “wash-away”.  If there was indeed a bridge, the boatmen would soon lose their livelihood perhaps until it would be washed away again.

Crossing the River at the Wash-Away

Building a Bridge over Troubled Waters

Mulanje

          We could go to Blantyre twice a month to get away from Nsanje.  Blantyre is the commercial center of Malawi. It has been over a month for me before going back. I intended to go back last week but I was persuaded to go this weekend as almost all the expats would be going to Blantyre and one expat knew I love the mountains and was entertaining the idea of going to Mulanje, the highest mountain in central Africa. 

I began to look into the website of the Mountain Club of Malawi and at the same time I wrote Doug P. who visits Malawi frequently, about visiting Mulanje.  I met Doug a few years ago when I inquired about the best way to visit the different tribes in southern Ethiopia on the website of Lonely Planet Thorn Tree forum.  He replied by asking if I would like to have a traveling companion as he would be in Addis Ababa and was also contemplating traveling to southern Ethiopia.  He tried to reassure me that he was not stalking me and invited me to peruse his MSF blog. I hesitated and waited two days before looking at part of it and we did travel together for two weeks and have remained friends since.

            Through him I was able to contact Gillian who is a member of the Mountain Club of Malawi and she happened to be going to Mulanje this weekend and so five of us: Gillian and Aiden from Ireland, Milan from Slovakia and Erin and I from the US started early on Saturday morning to Mulange. My fellow expat backed out the last moment preferring to stay in Blantyre.

            Gillian had already arranged for two porters and a guide.  Erin and I carried our own bags, we did not bring a lot, some food and warm clothes but Gillian who is a logistician for Mary’s Meals brought a whole lot of food and she also rented a sleeping bag for me. For this MSF assignment I was only allowed to carry 20 kg of baggage and so had left behind my hiking boots and sleeping bag.  Aiden and Milan were aiming to climb to Sapitwa, the highest peak. Erin and I would like to climb to the highest point but time constraint did not allow us to do so.

Half Way Up Mulanje

            Mulanje is 3002 meters, not as tall as other African mountains.  There is a lack of vegetation as there seems to be a lot of forest fires, many have been deliberately set by poachers to drive out small animals for them to hunt.   Despite that the ever changing hues and colors of the majestic mountain range left us in awe. At one stretch the new reddish brown leaves of the Brachystegia gave a splash of colors to the slope of the mountains. Parts of the trails were quite challenging, Mulanje is not such an easy mountain to climb. The sound of the crackling fire burning the bushes could be quite disconcerting and the charred landscapes make the mountains look bald.  Closer to the peaks the mountains look rocky. We soon ran out of water and collected water from the cool mountain stream for drinking.

The Pool at the Likulezi River 

          Almost at the end of a five hour climb we dipped into an ice-cold pool before climbing another twenty minutes to Thuchila Hut at 2000 meters.  In the evening we went down a trail and sat on a slab of rock with our wine watching the sunset over the Plateau of the Elephant’s Head.  The sun was a red fire ball slowly swallowed by dark grey clouds.  In the distant slopes we could see fires being started at several places. The first star silently made its appearance. On second thought I think it was really the planet, Venus.

Thuchila Hut

The Elephant's Head

Sun Set at Mulanje

          Gillian had prepared a delicious dinner at home and brought it up the mountain and heated it over a grate in the fire place.  When I first met her I took an immediate liking of her. For a large jolly woman she was quite an amazing hiker. She has worked in Africa for several years now first in the Congo and now in Malawi.  Aiden is a nurse working near Lake Malawi, Erin just arrived, a student in occupation therapy doing her internship in Blantyre, Milan, a friend of Aiden, is a computer technologist traveling internationally for Dell and had recently visited Penang, the island of my birth.  He was quite a stand-up comedian and made us laugh the whole evening long.  When he learned that both Erin and I are marathon runners and hikers he said to Gillian, “Next time when you invite us to come hiking please do not embarrass us with experienced hikers.”

            We slept on the veranda, looking at the stars.  In the early evening the Milky Way and the millions of brilliant stars dotting the sky, left us speechless. I could spot Orion the Hunter. This was the extent of my recognition of the constellations besides the Big and Little Dippers (Ursa Major and Minor) despite many a cold wintry night we spent with our astronomy professor in Wellesley on top of the roof of Sage Hall gazing at the sky and poring over the constellation chart. As we watched, a shooting star streaked across the sky.

            In the morning we said good-bye to Aiden and Milan who would be spending a second night scaling Sapitwa while Erin, Gillian and I headed downhill stopping at another cold pool of the Likulezi River near the bottom to have a dip. It was a weekend of peace with the mountains and nature and great company. After a few weeks in quiet Nsanje, Blantyre seemed extremely busy and I was glad to leave it for the mountains.