Blantyre Clinic

Today is our last day of clinic in Malawi. We are so sad to be leaving, but extremely proud of the work that we have  accomplished during our visit here. 

We have spent the last 3 days working at 3 different clinical placements and have seen a lot of patients. Our first day we spent at a children's rehabilitation center with Victor, a Canadian trained hearing aid technician who has opened his own facility with an OT/PT therapist. They have worked very hard and have a beautiful new space. We spent a 10 hour day testing adults and children, and fit about 40 hearing aids. It was a great first day! We missed working with the ABC students but were glad to have Victor and Lewis there to help.

The following day, we worked at the Queen Elizabeth Central Hospital with Dr Wakisa Mulwafu, the only ENT in Malawi, and several clinical officers. When we arrived in the morning, we had over 70 patients waiting! We started working immediately, but found that many of the patients were multiply involved and difficult to test. We also saw patients that had very sad stories and poor prognosis. At the end of a long day we were pleased with the number of patients we saw, but had to send so many patients away. You can only move so fast! 

Yesterday we worked at the Mulanje District Hospital about an hour outside of Blantyre. We spent another 10 hours working hard, and saw some amazing pathologies! We saw a patient with possible herpes zoster oticus on the tympanic membrane, one with no tympanic membranes which allowed you to see the round window and Eustachian tube, and several patients with blindness and unilateral deafness. It was a great day for masking and otoscopy! 

Today we will return to QECH to see as many patients as possible. We are all exhausted both physically and emotionally, but will put all we can into our day to serve the people that we can. 

Tomorrow we will spend a day at James' village where Victor is from, in order to present them with an oven and baking materials that we purchased for them, by donations from parents of recent ASU graduates and others in the department. We are so excited to see them again, they are an extremely welcoming community! 

We then travel back to Lilongwe to spend a day of relaxation before flying out on Wednesday. 

See you soon! 

Two ends of the spectrum

Well, Laura has pooped out on the blog so I'm picking up the slack. In all fairness, she needs to work on an assignment. Since our last submission from Mayoka Village we have been very hard at work at the Embangwani School for the Deaf. This is a residential school of ~120 kids ranging in age from 6 to 20 years. It seemed we tested everyone of them and fit or re-fit 62 hearing aids (using the Audioscan). We spent 4 nights and 3 intense clinic days. One of the side clinics while in Embangweni was a hearing screening at the primary school. Our goal was to randomly select 200 children to possibly get an estimate of potential hearing loss among the pediatric population in the regular school. Well, who knew it would be early dismissal for teacher training. We were able to get 62 children completed before they all escaped from the classroom. Not enough to tell us anything, but excellent practice for the ABC students. One of our goals was to try out an automated note pad screener. Although the idea is a good one, it did not do well in our conditions. Lesson learned: touch screen technology is a stretch for this population. Many of the children were too reticent to touch the equipment. While walking back to the deaf school, a woman from the village stopped us to request that we test her hearing also. She is a teacher at the pre-school. She heard we were in town and went to the primary school to find us but we were located at the hospital. She went to the hospital, but we were already gone. So, finally we connected. Turned out she did have a hearing loss and we were able to fit her a Phonak Valeo. PINK, as a matter of fact. Prior to our departure on Thursday, we went to daily devotion where we were treated to the best signed rendition of "Oh Happy Day". Following prayer we passed out note pads and pens provided by Rebecca and Peter Bartlett. These were definitely cherished gifts of all the children large and small. During our screening at the school the previous day, one of our team borrowed a pen from a 12 year old. He waited around to get his green pen back and would accept no other. Simple things we take for granted. Departing the school was difficult for both our team and the students. We developed strong bonds during just a few days. Many tears were shed. At this point we parted from our Malawian friends from ABC also. Peter led us in a reflection which was so perfectly timed to deal with all our feelings. Tears....again. We had one night back at Mabuya, then off to Zambia for another stamp in our passports. We are at Thornicroft Lodge just outside of South Luangwa animal preserve. Today (6-22) we went on two Safari's into the park, sunrise and sunset. Our driver, Martin, was the best. Sort of Morgan Freeman with Zambian accented English. We saw so many animals today that I can't even begin to list them. However, the highlights include: elephant, zebra (Ingrid's favorite because you can't have enough black and white in your wardrobe), giraffe (Gail's fav for unknown reasons), lion's, lion's matting (YES!), and thanks to Laura's excellent spotting skills, a leopard. Now this was not yards way, but feet!! Such an exceptional experience that we are all ruined from ever enjoying a plain 'ol zoo. Our list is huge and tomorrow we have two more Safari's. The food has been the best so far of the entire trip. GOURMET!! This has been a much needed rest. We work really hard and really appreciate the time we have to relax. I'm hoping we are modeling this skill as it is so easy to forget about recharging our batteries, and I don't mean otoscope batteries. I'm actually writing this from the bar, and no it is not for the liquid inspiration. It's actually very quiet as everyone is off to bed at 8:30 to rise before the sun for our next Safari. So by the time you get to read this (no internet here) we will be on the road to Blantyre for our next clinic. Stay tuned for more adventures from HFH 2013!! G

The Hearing for Humanity team has enjoyed a wonderful weekend at the Mayoka Village Lodge in Nkhata Bay. The lodge sits on the hill overlooking Lake Malawi and the view is spectacular. We ate well and some took swims in the lake did some snorkeling and walks in the village to take pictures and buy souvenirs. This was a much needed break after our hard work at the Karonga School for the Deaf and the Karonga Hospital. We saw incredibly sad cases of severe middle ear pathology that were so involved that the hearing loss was maximum, the drainage was thick and smelly, and even with treatment the hearing loss will be permanent. Every ENT in the USA should be required to do a rotation at a hospital in Malawi! It was a long drive from Karonga to Nkhata Bay and we arrived around 4:30 pm. Along the way we saw baboons and enjoyed beautiful scenery of the lake and the surrounding country side. The food at Mayoka is really good so we had a delightful dinner and in the morning enjoyed banana pancakes. Our morning was relaxing and we were happy to have internet again. Our bus driver, Nelson, had a mishap with the bus key (shut the key in the door and broke it in half) and had to catch a taxi to Mzuzu to get another key made. So, we hung around the lodge and took a walk to town. Peter and the ABC students then surprised us by finding us in town and we all piled into the bus to drive to the Khande township. Along the way we passed the Bandawe School for the Deaf where I hope to have a clinic next year. Our destination was the Mphatso Children's Foundation and to meet Robyn Casey who founded this organization. It is a remarkable place with more than 12 nursery and preschools and feeding centers. The place was filled with smiling children who were very healthy due to the food and educational stimulation that they receive at this center. Mphatso is located right on Lake Malawi and the ABC students and kids at the school had a rowdy game of football (soccer). The children were also super excited to have their picture taken and we couldn't even see Jenn because she was surrounded by so many kids on the beach. More information about Mphatso can be found on their website: http://www.mphatso.org. The center employs 60 people from the surrounding villages. As Robyn explained, 1 wage can impact 40 people; so the reach of this foundation is wide and very significant. After an afternoon tea we had the good fortune to be given a tour of the Makondwa Village by Poniso a young man who lives in the village with his wife and two children. Poniso showed us the Cassava fields and explained how both the roots and leaves of this plant are eaten. We saw the process of soaking the roots, chopping them and laying the Cassava out to dry. It is then ground to a fine flour and used to make nsima. The chief's house in the village had electricity and only one or two other houses. The rest had no electricity. We then headed back to Mayoka Village for a lovely dinner and bed. This morning we again had a delicious breakfast and hung out enjoying the lovely scenery. There were monkeys in the trees and they may have been given a few of our bananas. We are headed to Embangweni today but will stop to visit Liz and Bill Ottaway, expats from the UK who help provide services to the Bandawe School for the Deaf. Our next few days will be very busy testing hundreds of children at the Embangweni School for the Deaf and the primary and secondary schools. Likely there will be no internet access for the next week.

Good morning from Nkhata Bay!

Good morning from our favorite place in all of Malawi, Mayoka village in Nkhata Bay! We arrived yesterday afternoon and are enjoying a beautiful relaxing couple of nights in this fun, ecofriendly lodge located on the bank of lake Malawi. The weather is perfect and there are plenty of people to meet and get to know from all over the world. After several days of traveling in a cramped pink bus and working with patients, it is a much needed break. We will then head to Embengweni where we will test many many children at the school for the Deaf and primary/secondary schools. It will be a busy and challenging few days but we are excited to see familiar faces and get a lot done! 

Below is a picture of our view from the main hangout spot at Mayoka village and of our wonderful pink bus! 

Karonga travels!

6/11

We left for karonga today.....and I mean just left. We were scheduled to leave at 8am, but it is now 1:30pm and we are just leaving. What a mess this morning was. We were picked up on time by this massive pink bus van and the driver and manager thought we were scheduled to go to the airport, not 12 hours north to karonga. After some debate and conversation they, the manager and driver of the subcontracted company that's driving us, told us that we would need a permit to drive to karonga. They then dropped us off at the grocery store to exchange money and buy some bottled water. We then sat there for 3 hours! They literally left us to go argue with the contractor for more money! Because they thought we were going to the airport, they had arranged for the trip to be shorter and cost less money. And the only reason we know that is because we called the contractor and they explained that the driver and manager were in their office arguing with them. And then, when they came back they tried to lie to us and tell us that it took that long to get the permit. Terrible business and professionalism. Finally we got on the way and picked up the abc students. We have so much stuff and 17 people! Ridiculous. We won't get to karonga until 1am probably, which will be very late, since many of us have been going to bed at 730pm! 

6/12
We finally arrived in Karonga very late last night (1:30am) after an exciting and long trip from Lilongwe. We were all very exhausted and quickly fell asleep in our rooms with our bug bevies and sleep sacks. 

We awoke to the lovely sound of the rooster early this morning and walked with tired bodies to breakfast where we were served eggs, toast, sausage, rice porridge, and tea. It was delicious! We then left the Safari Lodge Annex and traveled to Karonga hospital where we set up shop in a couple clinic rooms. Some of our group went to the Karonga school for the Deaf and tested many adults and some children from the school, who had heard about our visit. Those who stayed at the hospital had a very busy day testing many adults and children who had arrives in need of our services. Overall, the themes of the day was drainage and bilateral conductive hearing loss. For those audiologists reading this, you know that that meant many masking dilemmas and referrals for antibiotics. We worked diligently and were able to see all the patients who had arrived today, as well as fit several hearing aids. 

Although today was our hardest day so far, we had great learning experiences with difficult patients, middle ear pathologies, and infection control. We are excited for a good nights rest and full day tomorrow! 

6/13

Today was a much better day for everyone physically, but emotionally it was a taxing day for us all. We continued our work at the Karonga Hospital and Karonga School for the Deaf, and worked efficiently as a group. Each person on the team was flexible and made changes in their plans and organization as needed. We were able to see many more patients and fit many hearing aids.

It was an emotional day for most of us because of the severity of middle ear disease and other pathologies that we saw. Almost every patient we saw had drainage, pus, fungus, perforations, chokestatoma, otosclerosis, cysts, or other outer and middle ear pathologies that are easily treated and prevented in the United States. It is very difficult to observe and test these patients knowing that the treatment available is limited and surgical intervention is often not possible. 

Although it is difficult for us to see these patients, it is a fantastic opportunity for us as clinicians to learn from each other as well as work independently to help patients through the developing medical system in Malawi. It also allows us to see first hand many of the pathologies that we learn about in textbooks and lectures. Also, it gives our students a lot of practice with masking! :) 

After working hard until after the sun had set, our group congregated by lake Malawi with some of the teachers from the school to have dinner and debrief. We had delicious chombo (fish) fresh from the lake and enjoyed sharing moments from the day. We also celebrated Tiwa's (ABC student) birthday!

Everyone was asked to share why today was different from yeaterday and what made it good or bad. Here are some highlights from the day. 

"Today was different because I enjoyed the silence. It's amazing how many things you learn in silence, while observing others and learning from them" - Mwasoni 

"Today I saw a story come full circle. I was able to see a patient who was tested yesterday come back into the testing room thrilled with his new blue hearing aids!" - McBride

"Today I had my first nonorganic hearing loss patient, ever!" - Mandy

"Today was different because there is so much middle ear disease that's preventable. And that makes me angry" - Belus (choking back tears) 

"I saw a beautiful sunrise today and started my day off well. It was just a good day." - Laura 

Weekend Fun!

Saturday we had slower day in clinic but saw some very interesting patients. We saw two patients with multiple disabilities and complex medical histories. The first was a young boy named Clifford who had I diagnosed cerebral palsy with stability issues, no speech, and a range of illnesses including malaria, impetigo and epilepsy. He was really difficult to test, but in the end we thought we had reliable results. However, we then used DPOAEs to cross check out results and had very contradictory results. We think he may have auditory neuropathy but are limited because the ABR/ASSR equipment is currently not working and we can't quite figure it out. 

The next patient we saw was a young girl named Evelyn who had some interesting craniofacial abnormalities. She was extremely sleepy so it was difficult to test her. She also had an ear infection in one ear and would not let us come near that ear. After getting some reliable results in the soundfield she began to fall asleep so we gave her a break and retested her several hours later. We were unable to obtain ear specific information so we were hoping to do ASSR on her this morning, however the equipment still won't work. It's so frustrating! 

After a full day of clinic we went out to dinner with the abc students and Peter. It was great to relax and have a good time with each other and eat some delicious food! It always such a hassle to go out to dinner with such a  large group, but oh well!

Oh, I almost forgot! We had the fantastic opportunity of attending a wedding reception of some abc alumni. It was an amazing cultural experience! There are so many interesting traditions like throwing money at the bride and groom while they dance with you, and auctioning off pieces of the cake to guests! It was beautiful and we are lucky to have the opportunity to see that. 

On Sunday we had a relaxing and fun day with the students and Peter. Many of us slept in and then went to church at a modern Christian church. There was a live band and fun songs to sing I'm English and Chichewa. We heard a funny and honest sermon from a young pastor who is also an abc graduate. 

After church we went into town for some shopping at a traveling market and lunch at Papaya. Many of us bought small souvenirs and enjoyed the beautiful weather. 

We hen traveled to Mt. Bunda, a very steep, short mountain outside Lilongwe. It was easily one of the most difficult hikes many of us have ever completed. It took about 30 minutes to the top, but was smooth, steep rock the whole way up. The view and weather at the top was wonderful! We took pictures and enjoyed the view, and then headed home for bed.

Today we had another busy day in clinic, following up with patients and seeing some new patients. Laura taught the students about Aural Rehab and counseling. We leave tomorrow for Karonga, which is almost to the northern tip of Malawi. We will work at a school for the Deaf and hospital, and then make our way back towards Lilongwe stopping at Embengweni and Nkhata Bay. 

Talk to you soon! 

ABC Clinic

June 6th was our first day in clinic at the African Bible College in Lilongwe. We spent the night before with the Bartletts and ABC students having dinner and sharing memories about our previous trip in June 2012. It was great to see familiar faces and for our new students to get to know our hosts. We ate delicious food prepared by the Barletts and prepared for the upcoming week in the ABC clinic.

Our first day in clinic was a bit hectic, with many patients to see and poor communication about the expectations for the day. As the day went on, we got into more of a groove and worked better together as a group. It's always a challenge the first day of work, as we need to adjust to a new culture and working style. Overall we were able to see 17 very difficult to test patients using conditioned play and visual reinforcement audiometry. Each patient took a long time to test, but we were able to get reliable results from most and fit a few hearing aids.

Alex, Kristina, and Mandy all lectured on various topics (OAEs/ARTs, anatomy and physiology, and the science of sound) to the ABC students. They all really enjoyed the experience and were grateful to the ABC students for being receptive and willing to learn new material. The students are very enthusiastic and ask many questions, which is so gratifying to an instructor. 

At the end of the day we debriefed, which allowed us to plan better for the next day and iron out the challenges we were facing. We established a plan of attack for seeing patients and talked about some of the patients we saw. Everyone went to be early since we were exhausted from a hard day's work. 

June 7th was a much better day in clinic. Some of us even wished we had more patients to see because we were so organized that we had little to do while patients waited to be seen. Many of the patients seen were around the age of two and scheduled for visual reinforcement audiometry. Almost all had multiple handicaps (blind, visually impaired, motor delay, epilepsy, delayed speech, Down syndrome, etc) and took time to test. As the day went on, we discovered that there was a need for ABR and ASSR because of the inability to reliably test these patients with behavioral measures. Dr. Belus and Laura spent a great amount of time in the afternoon trying to get the equipment up and running. In the end we were not able to run the ABR equipment but conducted ASSR on a few patients. Because it was late in the day, many of the young children did not want to sleep, and therefore were unable to be tested due to artifact from movement. However, we were able to confirm profound hearing loss in one child with no speech and delayed motor milestones. The patients who we were unable to test will return on Monday for more testing. In the meantime we will continue to try to get the ABR working. 

Naomi lectured the students on embryology and pathologies relates to audiology. The students seemed a bit overwhelmed at first but really enjoyed learning about how to diagnose many of the disorders that we see frequently in Malawi. One student mentioned that he loves the diagnostic portion of audiology because it is like putting together a puzzle and each test is a piece to the puzzle. 

Overall, our second day in clinic went much smoother and as a group we felt confident in our organization and testing protocol. No crazy things in ears yet, but I know Courtney is waiting for it! At the end of be day it was great to debrief about our successes and the patients we saw. We all went to be very early (7pm at the latest) because we were exhausted! 

The warm heart of Africa!

We made it!!! We successfully landed in Lilongwe after many hours of flying! We collected all of our baggage and are now waiting for the arrival of our friends to pick us up. On the whole we are pretty tired and jet lagged but really excited to finally be here! 

Here's a picture of some of us on the plane prior to taking off! Well update with more information as we can. Internet access is limited but we will do out best! 

Aisle friends!

Excited faces!

Ethiopia or bust!

We are 9/9 and so excited! We had a good night's rest in DC last night and are now boarding for or flight to Ethiopia. Hopefully we will get some sleep during the 13 hours over the ocean, but most of us may be too excited to sleep! 

Goodbye America, hello Africa! 

Off we go!

And away we go! Our group of 7/9 is checked in and awaiting departure at the Phoenix airport. We will fly to Washington DC for the night and then join our other 2 team members before departing for Ethiopia and then Malawi! We had quite the adventure going through check in and security with all of our equipment and action packers! They thoroughly inspected our audiometers and audioscan, but we had friendly TSA workers, even one with hearing aids! Everyone is happily settled with lunch as we wait to board. Here are some quotes from us about our excitement regarding the trip! "I'm leveled our right now....talk to me again in 4 hours" - Alex "I'm excited to begin the journey!" - Mandy "I miss my family and dogs! This doesn't feel quite real yet." - Dr. McBride Talk to you later!