There is certainly a focus on
prenatal care, but otherwise, women often get neglected. Indeed,
Malawi lacks resources, including basic medicines, which run out
quickly, but as Dr. Lungu said, what we need to do is change the
way people think. Women may be the “root of the family,”
as one clinical officer expressed, but there needs to be more
interest in cultivating that root.
Now at Mulanje Dr. Sue Makin and I and a visiting OBGYN are on
a campaign trying to encourage the use of speculums in examining
women. After seeing too many women suffering from inoperable cervical
cancer because no one ever bothered to examine them, it is time
to try to prevent this disease. We are also trying to teach the
medical assistants and the nursing students how to do the simple
procedure of applying vinegar to the cervix and observing if any
areas whiten up, indicating a possible precancerous lesion. I
feel, also, that if a provider takes the time to do a speculum
exam, he or she has added one more step to the thinking process,
hopefully making a more thoughtful diagnosis.
Seven months into my time, I am less surprised by the way life
and death walk so closely together here than when I first arrived.
On our way home Saturday evening, Sue and I encountered a minibus
that had hit a train. Minibuses are the main mode of transport
for people and the drivers are notorious for driving recklessly.
There is no 911 here, no emergency equipment, and so the locals
themselves were prying the front of the smashed minibus open to
rescue people. Sue and I took two of the wounded to the hospital.
It seems to be just another day to have a pregnant mother dying
of cryptococcal meningitis—should we attempt to rescue her
32-week baby by a C-section that the mother and baby might not
survive? Should we wait? A woman brought in a bundled-up baby
and when I put my stethoscope to his chest, I felt confused by
his warmth. There was no heartbeat. Our days at the hospital are
often marked by the sound of wailing from a ward that acknowledges
the mourning of another loss.
Change comes slowly here. One of my frustrations was that the
clinical staff hesitated to say the words “HIV positive”
out loud in our morning report. They used euphemisms like “ARC”
or “immunosuppression” or the issue was ignored completely.
The stigma associated with HIV is so big that the clinicians had
difficulty surmounting it. Now, I hear them saying the words,
even staging the patients according to the World Health Organization
guidelines. One of the staff confided to me that my insistence
that we be more open about HIV finally convinced him to approach
his sister about being tested. HIV positive, she is about to start
treatment.
Mtendere (peace),
Charlotte |
