Diary of an work in Malawi 1 – Settling into life in Lilongwe

Helen Brough tells us about her current work

I check my bag before I go to work: sunglasses, water, more water, Bible, torch.  Not the usual set of supplies required for a day at an audiology clinic, but then, this audiology clinic is far from usual.

I arrived in Malawi 5 weeks ago, to volunteer for 12 months at the African Bible College Hearing Clinic and Training Centre in Lilongwe.  My role is to act as clinical lead and offer supervision to the one qualified audiologist, three assistant audiologists, and three trainees.

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Arriving in a village for an outreach clinic

The working day starts at 7.30am with a 30-minute session of Bible study and prayer.  Twice a week we join the college chapel services, on the other days the clinic staff meet separately.  I particularly like Fridays, when there is more of an emphasis on singing.  One of the clinic staff will start a song and everyone will join in, singing in complex Chichewa harmonies.  Well, everyone except me, my Chichewa hasn’t extended much beyond ‘zikomo’ (thank you) and ‘pepani’ (sorry).  Those two words and a big smile have served me well.  I’m hoping to start language classes soon.

We often see patients with hearing loss from preventable causes, such as measles, mumps and malaria.  We diagnosed a boy with severe bilateral hearing loss in my first week here.  He’d had meningitis at the age of 6 and his family had been advised by a ‘doctor’ to wait 10 years and his hearing would recover.  Now aged 16, the boy has poor speech and has lost all hope of an education.

Last week we diagnosed a very shy 4-year-old with severe bilateral hearing loss.  She’d had malaria when she was very young, and either that or the treatment for it appears to be the likely cause.  How do you advise a family about expectations for speech development for a 4-year-old in this situation?  I started my training after the onset of the NHSP, I’ve no experience of encountering children this age who’ve had essentially no access to sound for their whole life.  Fortunately Lois, an educational audiologist, has just arrived from Australia.  I gave her a rapid summary of the situation and asked her to talk it through with the family.  Lois is hoping to work with some of the clinic staff (who are also trained teachers) to develop some sort of Early Intervention programme here.

I recently saw a lively little girl aged 5, I’ll call her Chisomo, who was diagnosed with a severe hearing loss when she was very young.  We first met last year when she challenged all my skills to get accurate results from a hearing test.  She’s full of beans and loves coming to play with all the toys at the clinic.  I spent a lot of time chatting with her dad last year about the importance of her wearing her hearing aids consistently.  She is now asking for her aids every morning and is speaking both Chichewa and English very clearly.  It’s so good to see how well she’s doing.

We have to be very flexible in our ways of working here.  Mains electricity is rationed, which is a constant challenge.  The power shortages are getting so acute that a couple of weeks ago Pete, the clinic manager, organised for the hearing clinic to have our own mini-generator.  The entire staff team had a tutorial one morning on how to switch from one power supply to another.  If we get it wrong, we could blow up the generator – we gave him our full attention!

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Kamuzu fixes the generator plug

We do what we can when there is no electricity.   Tiwa was busy making earmoulds in the dark one day.  Our regular earmould-maker hadn’t turned up, and moulds needed to be made; she knew what to do, and there was just enough light in the room for her to manage.  I found Kamuzu also sitting in the dark, busy rewiring a plug for the generator extension lead.  “I’ve never done this before” he said, with a big grin “I hope it doesn’t explode”.

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Tiwa making earmoulds in the dark

Tomorrow we head north to some villages near Lake Malawi for a 3-day outreach.  One of the key elements of ABC is the free programme of primary ear care and audiology services we provide nationwide to patients who can’t travel to Lilongwe.  The clinic staff work in partnership with local community groups who identify the need and make the practical arrangements for us, we then travel in a specially adapted Landrover towing 2 sound-treated booths in an audiotrailer.  We bring everything with us that we need except water, and quite often set up our services in a field.  Last year I was working in the metal audiotrailer which was parked in the sun, it was so hot in there that the patients were asking if they could go outside for a while!  I love the outreaches, it is a chance to explore this beautiful country with a group of Malawians who are very keen to explain their culture to me, and to visit places that have never even heard of a beaten track.

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The Hark! (mobile hearing clinic)

Come back for regular updates from Helen over her 12 month adventure!