I made a personal promise to myself at the beginning of the year that I would not let these blogs digress into a commentary on my gastrointestinal tract. If you have appreciated this goal then read no further. For those of you who are still with me, welcome to my level. During my first few months in
The problems which marked my first few months in
“This afternoon at Ayub’s… I think its just gas though,” There was a pause in the conversation as Jes rinsed her hair.
“Where does it hurt?” I moved to the left side of the bed so that I was visible through the open bathroom door.
“Right here,” I said, jabbing a finger in my lower right abdomen.
“Huh, weird,” said Jes as she turned off the water and began toweling off. I went back to massaging my abdomen for several minutes until Jes walked by on her way to the kitchen and said in an offhand way, “isn’t that where your appendix is?” My heart did one of those sudden big lub-dubs that is followed by near normal heart beats and a feeling of anxiety flowing from your heart to your extremities. I had actually already noticed that the pain coincided with my appendix but somehow having another person make the same observation added to the credibility. The pain was pretty minor though and I convinced myself that it would probably subside by morning. It didn’t.
The dull ache in my abdomen continued throughout the next week in both a very reassuring and disturbing way. The pain didn’t get any worse, a fact that I used to rationalize to myself that I was okay. The pain also didn’t get any better, a most unsettling detail that provoked worst-case-scenario dramas to play out in my head as I tried to sleep.
My medical options were slim; I could try to get the problem looked at locally or I could go to one of the private hospitals in
I woke up Sunday morning and the pain was worse. I tried to tell myself that it was worse because I had spent the last week pushing and prodding my abdomen, but the time for rationalization was quickly passing. It was at this moment that I realized how nominal my ‘health insurance’ really was. Jes and I had both purchased catastrophic travel insurance before we left the states. The policy, aside from having a high deductible, was pretty good. It would airlift you out in case of emergency and would pay up to two million dollars. Yet before you can be flown out of country you need to find a plane, that means
I decided that I had to act now as it would take a considerable amount of time to access medical care. I talked to Jes and we made the decision to go to
Monday morning came and the pain was worse. As I went to the breakfast table I felt my abdomen jarred by pain from the movement of walking. Jes joked that it was probably because I was so heavy footed, but her teasing manor couldn’t mask the nervous edge in her voice. I didn’t feel like eating so I drank a protein shake while Jes picked at some bread and mangoes. Sibale arrived at 8am. I stepped gingerly into the front car seat and bade farewell to Jes. We had both decided she should stay and pack incase we had to go to
The clinic was part of an Islamic charity that has a large compound with a school and a large garden. The school and the garden looked well maintained and I became hopeful that the clinic was equally cared for. It was, but unfortunately quality does not go unnoticed in
After five or six more seat changes I was the one entering the examination room. I was pretty thrilled; the queue had only taken about a half hour. Inside, there were two women, a small bed, a scale, and an old-school blood pressure machine. I immediately realized this was not the doctor’s office, just the pre-doctor screening. I guess there are hoops to jump through in every country. I was weighed (147lbs, okay I have lost some weight on the beans and rice diet) and had my blood pressure taken (120/80 – pretty good numbers, guess I am not dying yet). I was then ushered to the next, longer, line of chairs. To my relief, the door at the end of this line read, “doctor’s office.” Forty minutes later and I was face to face with a doctor with just enough gray hairs to exude a reassuring and competent manner. I had done some research on appendicitis and so tried my best to convey actual symptoms without imagined or embellished details which always occur after one reads what they are ‘supposed’ to be feeling. The doctor asked me some questions and did all the physical appendicitis tests. “Well,” he said, “I think you have acute appendicitis.” He started writing in my health book. Reading his scrawl upside down I saw the entry: refer to
“Mangochi is where we refer appendicitis cases,” he said in a voice that sounded like he used this line frequently.
“So they can treat appendicitis at the district hospital?”
“Well it where we refer patients for appendicitis.”
“I heard that,” I said, “but would you recommend going there?” He stopped writing momentarily and fixed me with a gaze that for the first time suggested he was pulling out of automaton mode.
“Well, if you need surgery you may want to go to
“Do you think I will need surgery?”
“In my experience most appendicitis cases are surgical.” He paused again, and then said in a rather frank voice,
“You should go to
“That’s what I needed to know,” I said, and thanked him for his assistance. He gave me some useful information on hospitals in
I decided to remain in Mangochi since it was on the way to
Jes and I had decided upon the 7th Day Adventist hospital which came with good reviews from everyone we talked to. Their slogan is: we care, god heals. I secretly hoped the hospital also healed, but was prepared to accept intervention on my behalf from any source. After proving that we had adequate financial resources (in my case, being white was enough), I was ushered back to a waiting room that was so cold I was shivering within minutes (in retrospect the room was probably in the 70’s, but these days anything below 80 is too cold).
My doctor was a young and very nice Chinese man with an American accent. He became excited upon hearing that I was here volunteering for the year. “That’s how I started out in
The surgeon also poked and prodded me and after asking several questions said, “I don’t think this is appendicitis; wrong place wrong symptoms. It could be an infected caecum. We will give you IV antibiotics tonight and if it doesn’t get better we will operate tomorrow.” The surgeon left and I picked up War and Peace and prepared for a long night in the hospital.
A small placard on the wall said, “Visiting hours strictly enforced. Patients will be billed for unauthorized visitors present outside of visiting hours.” The approved visitation times were very short and I thought the stipulation seemed rather strict. Visiting hours were also maintained at the hospital I worked at during college, but the rules were pretty lenient and almost anyone could visit at anytime if they checked in. The rules at the Adventist hospital also seemed at odds with the attitude of my doctor, who had encouraged Jes to stay with me, even through the night. The rationale behind the visitation rules became clear when, at 5:30, the hospital was besieged by an army of visitors. The halls were suddenly filled with a mass of talking bustling people darting in and out of rooms. My roommate had about 30 visitors crowed around his bed. Visitors entered the room single file dressed in their Sunday best. They all spoke with my roommate briefly, then relegated themselves to the far side of the bed and stood in respectful silence while others took their turn. Visitors entered in phases, and although there were never fewer than 20 people in the room, it was obvious the different visitors belonged to different parts of my roommate’s life. Some groups interacted with the intimacy and familiarity of family, while other groups were clearly professional associates. Many visitors, upon noticing my glaring lack of visitors, came over to talk to me. It was quite nice to have the company and I ended up meeting the author of the biology textbook Jes uses in her class. As much as I have bashed Malawian textbooks in past posts, his is one of the better ones. Upon hearing I was from
After the half hour visitation period had passed I gained a full appreciation for the strict rules enforced by the hospital. All the people are nice, but very exhausting.
My first night in the hospital (or any hospital for that matter) strangely reminded me of trying to sleep on a long airplane flight. People kept waking me every 3 hours to tale my blood pressure and refilled my IV. Jes, feeling guilty about sleeping in my bed in the presence of sisters (all the nurses are nuns), had been sleeping on the cement floor but after several hours of fortitude was overcome with weariness. The nurse, upon entering the room to find Jes in my bed, made a comment along the lines of: “what took you so long.” Morning came slowly but was punctuated by another half hour of visitation when my roommate once again entertained dozens of guests.
I spent the following day in the hospital in a manic cycle as my abdominal pain fluctuated from better to worse to better. By the end of the day the pain was a bit better and the surgeon decided that my problem was actually an intestinal block which should pass with proper medication. I was pretty stir-crazy by this point so was very in favor of being discharged. The surgeon agreed that I was probably safe to leave but recommended I stay close by until the symptoms completely disappeared.
I am feeling completely better now and am back in Mangochi. The experience made me appreciate how accessible quality medical care is in the