On The Depth of Inequality…

A common feat for visitors to Nkhoma Hospital is the few hour hike up Nkhoma Mountain which overlooks the hospital and on a clear day provides pristine views of the surrounding community. I had intended to make the journey a bit earlier but the task remained on the back-burner until my last weekend in town. And so on a late, lazy Saturday, I set off down the small dirt road near the local church where on the following morning choir voices would fill the air. I was out searching for a path intersecting the maize field, one of many starting points to the top of the mountain. Just about a week earlier, the Scottish students and I went on a reconnaissance mission and were able to find the path; this was the flimsy veneer of confidence which fueled my Saturday morning adventure. Some directions were better than none (thanks Anna!): when you get to the lake turn right, follow the path between the two peaks in the distance, veer left for the path to the mountain hut, behind the hut will be another path leading through the rocks to the top. Like the saying my fellow Kilimanjaro climber, Sid, passed on to me – when things don’t go quite right “T.I.A., man….This Is Africa.” This is Africa but I should have realized by now that when the limit of man is tested, something greater seems to intervene here. In my case, intervention came running down the road in the form of a fifteen year old Malawian who goes by the name Dalitso. Without so much as proper shoes, a bottle of water, or a second thought, Dalitso made a half-day commitment to climb the mountain with the lost, wandering American.

Dalitso and I had first met two weeks earlier when I was finishing up a late-afternoon exploration stroll with Claire. We stopped at the local soccer field to take a few photos of the action when Dalitso and his friend, Gift, approached us. Seconds later, I found myself with footage of street-side acrobatics. I should have known they had a trick up their sleeves…after all, This Is Africa. 

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Before we continued on our way, the boys scheduled a time to visit us at the guesthouse for a repeat performance – of course, we obliged. They ultimately came by twice to visit, once with a well-practiced routine and the second time just to chat. Only vaguely aware that their athleticism was a loose form of capoeira, a Brazilian martial art variant combining dance and music, these two may as well have been reinventing an art form.

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Our conversations started slow, two parties trying to find some common ground. Dalitso and Gift lacked access to internet or computers, they did not own a mobile phone, there was no live music for him to quench their thirst, and they knew nobody who performed capoeira. I had made the three hour journey to Lake Malawi the weekend before to chill out;  they lacked the expendable funds to make the one hour journey to the capital city of Malawi, Lilongwe. The outlets they spoke of were limited to television and watching movies he uploads to his flash drive from a rare computer. You see, it is cheaper to buy a decoder which connects your flash drive to the television, than to own a DVD player. The more words we exchanged, the more evident it became how different our lives diverge. We hadn’t planned on meeting again but somehow I found Dalitso and we walked the path to Nkhoma Mountain together.

At the pace we started walking the maize path, I knew the hike would be a challenge but I was grateful to have Dalitso’s navigation skills. About twenty minutes in, we hit the lake and then started a gradual ascent. He asked to hold my backpack so we could move quicker but I refused both because he was already helping enough and because I knew in about one weeks time I would set out to trek Kilimanjaro – and I needed all the extra training I could get. As we hiked onwards, our conversations delved deeper from politics to music to education. We spent some time on education – it was common ground. Dalitso also valued education, it brought out a passion in him which I hadn’t seen when discussing other topics. His favorite subject was science, at the moment, biology. Walking and talking made us thirsty. I had extra water and gave him a Nalgene to drink out of – he modestly refused at first but finally gave in when I showed him the three liters of water hidden in my Camelbak.

It was a challenging climb overall, as the rocky terrain meant using both hands and legs to power over boulders. As with anything worth doing in life, the hard work paid off. The views from the top were truly breathtaking. I was in good company and with good company came good conversation.

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I had a half-loaf of bread in my backpack which I gave to Dalitso at the top – I was exhausted and far from hungry but it was lunchtime on just another afternoon for him. The kid struck me as both bright and generous, a lethal combination which has the power to make even strangers feel comfortable. After some time relaxing at the top, he asked me “Do you know where I can get college scholarships?” He caught me by surprise and I lacked an adequate response. I had no information and had nowhere to direct him. Back home, we have resources at our disposal. We can Google anything and surely get a response; the limiting factor is time and energy but on top of that mountain, I had nothing for this kid. Doritso responded that he would figure things out when the time came. He laughed it off and changed the subject. Dalitso asked how we would keep in touch because when I left he would not have any Americans to chat with. Again, I did not have an answer. He lacked access to phone, internet, and money for postage would not be money well spent. I knew the chances of us keeping in touch were slim, but we both agreed that one day when he found access to internet he would email me – it seemed our only viable, semi-optimistic option. We soon found ourselves with less to talk about on the way down the mountain; I was deep in my own head and I suppose it takes two to conversate.

You see, when I look down from a birds eye view, my world really does seem flat. My world is as large as I have read, seen, heard, and built with my imagination. I believe the world we find ourselves in is only as large as our minds are able to travel – and this variable changes based on our environment and temperament. One must be both willing and able to push the mind’s limits and expand boundaries. Malcolm Gladwell writes about outliers and how a genius-like quality is not necessarily inherent in an individual but a product of nurture and environment – I think there is so much truth in that. A core difference between those in underdeveloped parts of the world and me remain clear: I have access to the endless amounts of information on the internet, through books and libraries, movies, televisions, and Universities. More importantly, I am surrounded by people who share in this endless information so that our daily exchanges continually expand our body of knowledge. Doritso is limited by access, crippled by a system with weaknesses he has not yet grown to understand; weaknesses certainly beyond the control of his generations passed. The weaknesses are deep engraved and I humbly acknowledge my limited insight. I am far from an economist, banker, or historian – so if my interpretation is wrong now is when you should feel free to step in and shed light.

Let’s start in the private for-profit sector. What benefit is there to support a country where local currency is weak, infrastructure poor, fruits of the land uniform (maize and tobacco), and its population generally uneducated. I am genuinely not sure but the Chinese are betting on Africa’s future, as can be seen through their government donations for buildings, such as the one set to be the tallest in Ethiopia. From the non-profit sector much is being done it appears – all the foreigners I met seem to be volunteers or aid workers contracted both through governmental and NGO operations, undeniably a worthy cause. They are admirable for providing essential short-term change and optimistically laying the groundwork for long-term development. Change is slow – this is true and likely Obama’s next campaign tagline.  I challenge though that the longevity is at risk in a country plagued by systemic problems which cause everyone to take three steps back before being able to take two forward.

There is a current fuel crisis in Malawi – which seems to have been ongoing for a few years now, to the point where gas stations have signs that say ‘out of fuel’ and vehicles line up waiting for fuel trucks. The cause of the fuel shortage depends on who you speak to but the most plausible explanation is the weak Foreign Exchange. The currency of Malawi, the kwacha, is weak and US dollars are scarce. Some locals think the crisis is more due to the United Kingdom limiting aid to Malawi after Malawi expelled the British ambassador for criticizing South African leadership – seems like a possible contributing factor. Regardless of the cause though, demand remains high and supply low – fuel prices are rising from the existing high prices seen in the world market. With the cost of fuel up, so rises the price of travel and doing business. The effects are seen when shopping in Malawi – both necessary and luxury goods are expensive and I’m told steadily increasing. How can people with significantly less earning power spend the same as we do? Food shortages are common and widespread – leading to a current hunger crisis. With malnutrition comes increasing rates of disease, increased mortality rates, and decreased life span – a sick cycle of destruction. And although this would appear to be a worse case scenario, people of Malawi are thankful that the country is free from violence unlike others nearby.

Then, there is the issue of devalued Malawian currency. The bank rate is roughly 160 Malawian kwacha to 1 US dollar. But, in the parking lot of the main market the kindest thug looking gentlemen will change your money at a black market rate – with 50 and 100 US bills getting roughly 280 kwacha to the dollar. I have heard if you change 1000 dollars during one transaction, you can get a rate of about 400 to the dollar, more than twice the bank rate. Malawians are paying a premium for dollars but at what cost? The fact remains, they have no other option to play at the table. Devaluation of currency is a complex topic and probably deserves some space on my bookshelf – the whys are always tough questions to answer.

I have always believed that you can see the intention of a man when you look into his eyes and Dalitso was a good, honest kid striving for more – hungry to achieve. He carries the weight of the world but walks with a pride that amazes me – and I’m proud to have had the opportunity to look him in the eye as an equal – he deserves it. Despite our differences, we share something in common; like so many others, we are striving to achieve something bigger than ourselves. His dream was to come to America, something I did two days ago when I returned home – a bittersweet thought. Dalitso reinforced an important fact to me – the depth of inequality in this world is growing. With every day that passes, so passes time which adds exponentially to the centuries of unequal growth between corners of the world. As we speed ahead, many will stand still. There is no good way to end this post but to hope that those who are in positions to make an impact are choosing to do the right thing, not for themselves but for the greater good. It is easy to forget that we are products of circumstance.

On The Simplicity of Difficult…

I write to you from the city of Arusha in Tanzania, where I have arrrived two days ago after spending three great weeks in Malawi. Due to unreliable electricy and poor internet access at Nkhoma Hospital, combined with my inability to sit still behind a computer which took forty five minutes to load Gmail, I have regretfully not been updating Weight Of The World regularly. I have so much to share though so I have decided to start transcribing entries from my journal that I have been keeping. The stories will appear out of order, my thoughts may appear scattered, but it remains a reflection of what I experienced and how I interpret those experiences. My interpretation will evolve as I leave Africa and transcribe from the States, as my perspective will slowly change from this slow-paced state of mind back to the fast-paced world we find ourselves in. Additionally, fact-checking was hard to do during the journal writing, as again, access to internet or ‘factual’ information was unavailable – so I guess for a short-time I found myself in the shoes of so many others around the world who lack easy access to information, internet, tv, etc. To be cut-off is as much relief, as it is burden, but allowing the mind to roam free, reflect, and reach its limits are invaluable. I depart for Mount Kilimanjaro tomorrow. Plans have changed a bit, and I will be climbing with others via the 8-day Rongai Route with a night camping on the crater. This is the only route to traverse the mountain from North to South pattern, so it should prove to be interesting. I am not judging my success based on how far I ascend Kilimanjaro, for climbing this mountain is certainly a luxury after seeing first-hand the suffering that is taking place in Malawi. I hope that this finds all my friends and family well and in good spirits – we have a lot to be thankful for and so much to smile about – it would be a shame to let our ourselves get the best of ourselves.

Nkhoma Synod CCAP Hospital sits upon a hill, approximately 50 kilometers from the capital city of Malawi. The brick and mortar hospital buildings limit views of the surrounding lush, rolling hills and maize plantations. Unless you stand on the outskirts of the hospital grounds, you may forget the sky blue horizon is interupted only by small mountains. A gorgeous setting indeed in a hospital which is as much outdoors as it is enclosed. It is hard to believe that someplace so beautiful places the burden of life in hands tied by limited resources but alas that is the story of those who I meet in Nkhoma.

Upon arriving to Lilongwe International Airport, a quaint airport with only two checked baggage carousels, I was greeted by a large police and military presence. My arrival coincided with that of the controversial President of Malawi, Bingu Wa Mutharika. On the single road out of the airport towards the city, our vehicle had to pull to the side to allow for the Presidential motorcade to pass – a combination of green army trucks and multiple black Mercedes Benzs’. It proved to be the start of quite an interesting trip.

My first impression of Malawi based on paved roads, a central market, and very few beggars was that of a developing country on its way up but the more time I spent I found this to be untrue. To a passer-by, Malawi hides it’s poverty well. The average Malawian is certainly poor by the world’s standards but they have carved out an existence to the point where poverty and lack of housing is hidden from main roads. Malawians make do with what they have, a simple principle that stood the test of my time spent there. So simple, but one I must repeat because I often lack this concept in my life: making the best of what I have. I need to that more often because it brings humility, and it should not be hard, Malawians do it everyday.

The Malawian diet is a clear example of this simplicity. Maize seems to be the main farmed agriculture as well as a staple of the diet, as it is charred and sold on make-shift roadside grills. Ground maize is also made into a flour and boiled to make Nsima, a thick starch that is consumed during mealtime with one or two relishes, generally boiled pumpkin leaves mixed with tomato and onion, and if lucky, a protein – chicken or egg. Nsima is filling to the belly, relatively inexpensive, and readily available. Many Malawians would not go a day without Nsima – in other cultures, a food with similar qualities is white rice.

At the hospital, all patients checked into inpatient wards must have a guardian present throughout their stay. I think the reason is two-fold: one so that someone is present to attend to the patients needs, as support staff is limited, but also because someone must prepare food as their is no hospital food service. There is an outdoor area where smoke rises from large pots, as people combine their flour to make Nsima. When families cannot afford food, I have been told it is not uncommon for them to share. The always smiling and generous hospital interpreter, Pearson, told me that Nsima is a food meant to be shared and never to be made just for oneself. One evening, he taught our guesthouse how to cook Nsima – and it was the best I have eaten in Malawi.

The ‘simplicity’ of the difficult life led in Malawi is not a choice, but a forced adaptation to the environment. Electricity is a luxury, as the service can be interupted for days without notice. This certainly had an effect on my eating habits, as cooking was on occasion confined to a single propane tank shared among a house full of students, but this was a first world problem when compared to the hospital losing power for extended periods of time. While I was there, the hospital back-up generator was in and out of repairs, so when the power went out and the generator failed to function properly, patients were unable to recieve oxygen. Pediatric cerebral malaria is a challenge to manage by Western-trained physicians who are short-staffed to begin with, but even more an uphill battle when children cannot recieve oxygen to limit cerebral ischemia and brain damage during seizures. No power meant no x-rays, the only imaging modality present outside of ultrasound, for which there was no skilled operator. Lack of power was not the only barrier to getting x-rays. The processor for the x-ray machine was broken for the majority of my time at Nkhoma, so patients either had to travel 1.5 hrs by vehicle to another hospital for x-ray machine, often unfeasible due to cost and patient condition, or we relied on clinical judgement for patient care. In terms of medical education, having to rely on clinical judgement in a resource-limited setting is a life-changing experience. More on this topic later.

So in all, from this entry I think the most important thing I took away is that in Nkhoma the challenges are many, the causes multi-factorial no doubt, but in general Malawians seem to do the best given what they have. There is no time to complain when people are dying. There is no one to blame when blame only brings angst and angst is the bottomless pit that eats away at the soul. You wake up, smile, celebrate life, value human relationships, and make the best of what you have.

$1000 Fundraising Goal Exceeded! Thank You!

ChipIn Final

My sincerest appreciation goes out to all those generous donors who helped exceed my fundraising goal of $1000. Aside from the big hearts who have donated quietly online, a strong thank-you is in order to all the brave souls who fought Chicago’s brutal Winter to attend the fundraiser at aliveOne on Thursday, Jan 19th 2012. Although we had a small army, our strength was obviously not judged by our size because we exceeded the fundraising goal by 10%. Though they are likely too modest to ask for praise, I must shed light on the wonderful people running aliveOne bar in Lincoln Park. At midnight, they made a donation of $150 because they truly support what we were trying to do that night. Lastly, a special thanks to Hope Ascents for continuing to enable individuals like myself to climb mountains for charity — I believe in your cause fellas.

Fundraising was only the first step forward. In 7 days, I depart for Nkhoma Hospital. My flight lands in the capital city of Malawi, Lilongwe, after lay-overs in Washington D.C. and Addis Ababa, Ethiopia. After a 2-hour ride to the hospital, I plan on staying at the guesthouse dormitory, which historically served as the school hostel. I haven’t the slightest idea who else, if anybody, is staying in the guesthouse.

A previous email from Nkhoma Hospital included the following note: “The communal kitchen has a microwave oven, a conventional oven, a fridge, a freezer, cutlery and cooking utensils. You must provide your own food, unless organised in advance through the guesthouse management. Food can be bought in Lilongwe or Nkhoma. Nkhoma has a market from Monday until Saturday and a bigger market on Wednesdays and Saturdays for fresh seasonal products and fabrics. Most western foods and spices can be found in Lilongwe. Shoprite, Peoples supermarket and Metro have good supplies, the prices differ a lot per shop. In the guesthouse, there is filtered water available, therefore no need to buy it in Shoprite. Tomatoes, onions, eggplant, pumpkin, avocado and cabbage are vegetables, which are available at Nkhoma, and are usually cheaper than in Lilongwe. Banana and oranges (mandarins) are also available in Nkhoma and in season mango, papaya, passion fruit and sometimes pineapple. Rice, pasta, sweet potato, Irish potatoes, cassava, salt, sugar, bread flour, yeast, oil, bread, rolls, eggs, cocoa powder, instant coffee, tea leaves (no bags), coconut cookies, long life milk and soft drinks (coca-cola) and sometimes peanut butter are also available in Nkhoma.”

Maybe I’ll just go on one of Steve Job’s vegan-minded fruit diets while I’m out there. Anyways, this week wraps up my rotation in the Emergency Department at Stroger Cook County and will leave me a few days to get my head right for the trip. Thanks for checking out Weight of the World, and a huge thank-you to everyone who has donated to Nkhoma Hospital — together we made one step in the right direction. So long as I find internet access, I will be updating this blog so stay tuned in…but feel free to drop out :)

Nkhoma Hospital Fundraiser @ aliveOne Bar Chicago – Jan 19, 2012

Join me for an intimate evening of cocktails and live music to support my charity climb up Africa’s tallest peak, Mt. Kilimanjaro. 100% of donations will go to Nkhoma Hospital in Malawi, Africa, where I will spend 3 weeks training and treating patients prior to the arduous climb.

Why Nkhoma Hospital?

They are providing a sustainable model of healthcare to a rural community crippled by alarming rates of HIV, TB, and poverty in one of Sub-Saharan Africa’s most population-dense countries.

Donate to my charity climb today through Hope Ascents: www.hopeascents.org

Date: Thursday, January 19, 2012
Time: 6:30pm – 9:30pm, with live funk band following the event
Place: AliveOne Bar @ 2683 North Halsted Street, Chicago, IL, 60614
Cost: $7-$10 suggested donation at the door
House Specials: $3 Three Floyds drafts, $3 Absolut cocktails

Thank you for your continued support!

My Defense of Visiting Africa in the New Year: By Devin Mehta

By DEVIN MEHTA

Well, I’ve reached my tipping point and the thoughts inside my head have flooded to your end of the internet. This is truly my first original article or at least an inspired attempt at one. When you have no readers, not a lot is on the line – trust me.

This past year has allowed me to see more clearly, to appreciate the clarity more so than in past years. I am in a place where I can stand with two feet firm on the ground and build upon my fleeting glimpse of the bigger picture. Today, one day before the start of 2012, is an opportune time to reflect on that which I have to be thankful for and that which I must strive to become.

I’m thankful to be alive. Among the various tragedies we may have experienced this year, I continue to feel the lingering sting from the loss of an old college friend who was a great, yes great man. From loss, I gained more compassion. Introspection is the next step of my poorly defined plan to enlightenment. I have made mistakes and poor decisions. I have hurt people with the least of intention; I have not always been the man I ought to be. So in 2012, I will continue to learn from both my successes and mishaps to become a kinder, wiser, more responsible human being.

A hospital is a trying place to spend most hours in the day – a roller coaster of highs and lows – but in retrospect, the work is truly the most humbling medicine. I am thankful for the opportunity to treat patients, to be at the intersect of where science meets humanity. The journey is the reward. With my eye to a panoramic lens, I often waiver when considering the impact, or lack thereof, that physicians have on greater society but it would be naive to think the answer comes without experience; so onward I tread. Two things do remain clear to me – modern medicine has expanding limits and when those limits are reached we balance on the tightrope of faith, and secondly, life is too fragile to be taken advantage of because a crack will inevitably spread to cause the glass to shatter.

2012 will be a year of catalytic growth for me. I begin the year working in the County ER, the arguably busiest emergency room in Chicago. Wisdom will be the dragon I choose to shoot. Positive momentum will continue as I depart for Africa to complete both a global health elective in Malawi and a charity climb up Mount Kilimanjaro in Tanzania.

Why Africa?

I could say I’m traveling to Malawi to help treat a population that hovers between an HIV infectivity rate of nine and eleven percent but that defense would be disingenuous. I could say that as humans are traversing the world with increasing ease and frequency, global health experience is an asset to the modern physician; again, disingenuous. I’m traveling because when I am forced to live outside my comfort zone, I will break down the walls of my mind. I believe life is not and should not be defined by smart phones, binge drinking, television, and high fructose corn syrup (as I multitask while typing this: syncing my iPod, charging my Kindle Fire, streaming ‘Breaking Bad’ on Netflix, and planning what bottle of booze to bring to the NYE party). I may well be a part of the problem, or shall we paint a brighter connotation – I may well be not passionate enough to occupy anything. So I travel to learn another way of life, to clear my mind, recharge, to identify true needs and wants, to appreciate what I have back home, and most importantly to remind myself what the world is like outside the comfort of a continent that lacks genocide, child labor, and violent political regimes.

I have traveled to developing countries before and I will continue to do so to prepare myself for the future. I am the first to admit that my work abroad may not offset the carbon footprint of my travels but by treating patients in rural Malawi now, I keep my two feet close to the ground so I can continue to build for tomorrow. I am thankful for the welcoming hands of Nkhoma Hospital in Malawi for the opportunity to experience the delivery of healthcare in an environment with limited resources to patients with socioeconomic problems unlike that which I have previously encountered. Foreseeing death of a patient because of an inability to afford a course of antibiotics is something I am prepared to deal with and learn from. That is why I am headed to Africa.

Upon returning from a backpacking trip through India prior to starting medical school, I recall thinking to myself that there was no better feeling than returning to a familiar place with familiar people, home. I respect most the individual that has found their strand of enlightenment without having to travel far and away. One does not need to backpack the world to see more clearly. In our own backyard, there is untreated HIV, poverty, deplorable living conditions, growing healthcare disparities, racial discrimination, prostitution rings, a thriving drug industry, and gang violence. Making a positive impact here locally is no less important than making good in Malawi. I tip my hat to those who work tirelessly to treat under-served populations yet are unable to bask in the exotic, trailblazing glory (not really) of global health.

Beyond Malawi, in late February I will head north to Tanzania for my first attempt to summit Mount Kilimanjaro, Africa’s highest peak. In fact, this will be my first attempt to summit any mountain. I chose to do a charity climb to support Nkhoma Hospital, the same hospital which I will have spent three weeks training at. I sleep at night knowing that I am contributing one hundred percent of donations to a hospital which I will be taking so much from in the form of experience. A small thank you to the community I will be learning from. The generosity of donors thus far is moving and makes me appreciate even more the kind people who I have surrounded myself with.

Thanks to the great nonprofit organization, Hope Ascents, preparation is well underway for the arduous eight day trek. Mentally, I know I’m prepared. After three weeks with Nkhoma Hospital, I will light a fire within me to reach the limits of my mind. Physical preparation is also underway – correction – moderately underway; this has proven to be more challenging as I have never been one to run marathons, but, with the start of 2012 comes motivation to train harder.

With the New Year comes renewed spirit – a commitment to grow both personally and professionally. I thank those who I’ve crossed paths with; those who have helped build my moral compass. I look forward to those who I have yet to meet. There is so much to be happy for yet so much improvement that needs to be made. For every plate full of delicious food I will consume at the New Year’s Eve party, I will acknowledge that there are hungry children across the world dying from malnutrition. Of the approximate 7 billion people on Earth, there is an estimated 925 million hungry people, 13.1 percent of the world’s population, almost 1 in 7 who are hungry [1]. I suppose that is the weight of the world.

Devin Mehta is a fourth year medical student at Rush Medical College in Chicago, IL.

References: [1] worldhunger.org