fellowship training, International health, Malawi, medicine, pulmonary and critical care fellowship

“Tionana mawa”, See you tomorrow

Outside Queen Elizabeth Hospital, we walk along the side of the road toward a collection of minibuses parked outside the Red Cross stop.

Elizabeth, my field worker, exchanges a few words in Chichewa with the mini-bus attendants, and we quickly shuffle into the minibus designated South on the M1 towards Manasi. I dole out 150 kwacha (less than 25cents) each for the journey for me, Elizabeth, and Vi, our student.  Snuggly, we pack into the minibus; my view from the back is not uncomfortable, as we are only 11 when maximum capacity is 16 seats.  IMG_1629

The minibus is sputtering as the driver tries to get it to leave the station.  I notice three young men pushing our minibus as it is propelled to a rickety start, and then we are off.   Inside the vehicle, every bumpy rock and pothole is felt under our chairs.   Two Malawians speak to us in English. They are visiting relatives at Queen Elizabeth Hospital. They ask us how our experience in Malawi has been.  It is unusual for foreigners, or mazungus to ride along the main public transport system for Malawians.  We chat back and forth and then after 20 minutes say goodbye to transit to another bus for the village of Manasi.  Manasi is where one of our study participant lives.

We disembark the minibus and walk around the village and inquire after our participant’s whereabouts.  Here in Malawi, there are no such laws such as HIPAA.  Usually your friends, family, and especially your village community always know exactly what is going on in your life. But no one knows where he is.  We have no address, we just have a 5 sentence long description that goes something like “from Queens, board the minibus towards Manasi, get off at the exit, walk to the village entrance, then pass by landmark A, and walk three houses, and ask for XYZ.”    We decide to call him and luckily reach him by the phone.  He asks us to wait for him at the entrance of the village and warns us that it will be quite a bit of a walk to his home and for us to be prepared.  We wait about 20 minutes and then he appears and asks us to follow him. Together, we walk away from the M1, coolboxes in hand down crooked dirt paths, passing by curious children and families washing their laundry in a coursing stream.


After about a 20 minute walk, we are ushered into his home, and the participant, P, kindly offers us step stools to sit on. I make note of his socioeconomic status observing his tin roof, windows/ventilation, a locked home,  and cemented floors… all indicators of wealth/position in this society.  IMG_1653Elizabeth starts the rehearsed script in Chichewa, and informs him at each step what she will do.  She proceeds to collect each of the environmental samples including drinking water, dirt, and she places the air filter with the battery operated pump onto his belt.  Afterwards, I give her some feedback. I compliment her on what she has done well, including answering questions and explaining each step as she went along.  We conclude the visit, thank him, and make our departure.  “Tionana mawa”, or “see you tomorrow”, we tell him, for the bronchoscopy visit.  We then set off and rode the same two series of mini-buses back to the hospital.

Back in the lab,  I assemble the water bottles in an orderly fashion.  I manually push each 500ml of water using a sterile 60ml syringe through a filter membrane intended to trap the microbiota.  IMG_1682I then store the filters in -80deg Celsius freezer.   The other environmental samples are frozen as well and batched for bacterial DNA extraction at the end of my study.  When we see P again mawa, we will take the battery operated air pump off of him and disconnect the filter. Usually the filter becomes coated with a slightly gray layer of dust, visually illustrating the high amount of biomass that is in the ambient air here in Malawi.  I wore an air pump and filter on myself in the US and the darkest I ever saw the filter become was wearing it around a bath and body works candle at home.  Here in Malawi, there’s plenty of biomass burning in the ambient air to explain the discoloration.

The next day, P and other participants arrive for bronchoscopies.  They have all worn their air filter pump correctly from what I can tell by the data. Their only feedback to me is that it is very noisy and it kept them up at night.

One after another, they each get bronchoscopies under local analgesia without sedation.  They tolerate the awake bronchoscopy well (as well as anyone can, without a little benzodiazepine to forget about the whole thing).  I run the samples to lab and we process them immediately for immunophenotyping.  This is what a BAL slide looks like that I made.img_1675.jpg  If you can tell me what cells are on there I’ll buy you a Fanta, a drink of luxury.

That is my day to day life.  I really enjoy the work here. I don’t highlight the frustrations and hurdles here because I do not think it’s the right platform for it.  I write because it reminds me of what is good and grounds me in what matters.  The work friends I have  made in the lab are entirely wonderful.  After each weekend, I look forward to seeing them and interacting with them.  I also have just the best study participants.  They are such faithful people, and do everything they can to keep their word and do as they are asked.  The air filter is such a noisy thing to wear, but each of them do their best and never really complain about it. We have a 25% lost to follow-up rate, but I think that’s usually not their fault. Most Malawians give you their word and you can count on it.

I think about the 8600miles I have traveled to be here and how this research project has bridged the gap between me and Malawians.  I feel incredibly blessed for the privilege of knowing these people.  If the currency of wealth was measured in the number of people that open their hearts to me into their lives, I may be a contender for being the richest person on earth.

There is a song called “This is Africa” by a rapper from Ghana and one of the lines goes like this:

“Malawi, Ethiopia got beautiful people.”

I’ve never been to Ethiopia, but Malawians are lovely indeed.


3 thoughts on ““Tionana mawa”, See you tomorrow”

  1. What a great experience! Plus, your BAL sample looks beautiful. As a side note, I am sure you will love reading these later- it brought back my own memories as a mazunga on the crowded matatus. Can’t wait to hear more when you get back.

    1. Katie Sears, that BAL sample was probably the best of 20 I did. The others look terrible because of debris and various other factors, but I save those for my own archives. 🙂 Matatus in Kenya are exactly the same! You are totally right.

  2. Not everything is lush green where you are . . . thank you for letting us experience more of your daily life and surroundings. I’m still in awe of your words and pix . . . In days to come, you have this “diary” of what in yrs to come may be a faded memory.
    Praying, of course . . .

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