First time really being a cancer doctor...

Over the past week, I have been seeing my friends mom and working her up for a breast problem which did turn out to be cancer. This is my friend who is well educated, wealthy family, spent lots of time abroad as her dad was diplomat. She owns one of our favorite restaurants in town. She was one of the main organizers for the Think Pink breast cancer awareness event in October. She called me because her mom had this swollen breast  that she went to 2 different doctors for and they each prescribed her antibiotics. Lets pause here, the chance of a 67 year old otherwise healthy women having a serious breast infection is pretty slim. It wasn't getting better and they got an ultrasound, which was also inappropriately interpreted. The mammogram, even though they could afford it, was down.  Finally I saw her and knew right away it had to be cancer, and pretty involved, with the appearance of her breast. We did a biopsy and came back as invasive cancer. I sent her for a full staging workup, which fortunately they were able to get and ultimately she was a stage 3. I first told my friend and then her sister in person when they came to get referral letters and drop off results. On Monday, we met them in clinic with Satish and Bongoni (Satish's clinical officer) and spent nearly 2 hours discussing everything. I was the one who was in the room by myself with them and had to tell her the diagnosis. she was shocked. she didn't expect or even think that was a possibility at all---which also just demonstrates the lack of awareness and knowledge about breast cancer in Malawi.  I have been present for this conversation as a medical student and resident many times, but this was my first time that I had to tell a patient that she has cancer, and that its advanced. It was hard. Satish joined soon after and took over most of the conversation since she needs chemo first. They are currently discussing if they will stay in malawi or try to go abroad. It sucks that this all happened as i'm leaving, but i'm glad I got to see her and do the right thing before more doctors sent her astray and only prolong diagnosis and reduce treatment options. This too makes me hate leaving. I feel so much more useful in Malawi and like I can really make a great impact.

Tiwonana in 6 weeks!

I'm currently at the JoBerg airport on my long layover to NYC. The last 2 nights were nice but of course bittersweet. I'm really glad i'm coming back at the end of August so i will still be able to see most of my friends and of course a more manageable time to be apart from Ben. Actually the last 2 summers we spent 4-6 weeks living in different places (Boston- NC and Malawi-NC). On friday night, I had an impromptu farewell dinner at one of my favorite restaurants in town--Fantasia, korean. Tuesday during the day we had a nice lunch with Jared. Dr. Charles was supposed to come, but got stuck in the hospital. Our last night we moved some of the stuff i'm leaving into Ben's new Malawi home which is very nice, hung out with a friend for like 30 minutes while we had an electricity outage. Then I made us a feast for dinner.

Last weekend in Lilongwe...at least till vacation in August

We had a fun and relaxing weekend, just hanging out with friends and hanging out with each other. Friday night we had a few friends over for dinner. Saturday Ben played 2 soccer games adn we had dinner with other friends at night. sunday, Charles my tailor came over for last time. I will really miss him and his amazing work. We had a lovely breakfast, watched shows, and had a couples massage. At night we had dinner with a really interesting work colleague of Ben's, another consultant, but with a quite  dynamic and international career.  I'm sad to leave this great life we have here!

Last quiz night

It's been a fun year playing quiz night on team "Dirty Kwatch." This was probably my last one :( unless there will be one in August when i come visit. We did pretty well at least!!

Marta's Going Away

Last week it was Chris (and Lauren from week before) now it's Marta (one of our Italian friends). We went to Mamma Mia for dinner. I will miss her, but she will likely be starting a new job in Mexico City in September so it will be close enough to visit I hope!

Return Home :)

Lilongwe definitely feels like home now. I arrived back last tuesday and its been really nice to be back and also really sad to be leaving so soon. One of the couples we were really good friends with now left so it was sad to say Bye, but they they live in London so we will definitely be able to see each other, which i'm very much looking forward to. We had a fun weekend of Malawi World cup soccer tournament where Ben played on the Australia team even though there was only 1 Australian.  We saw the Vagina Monologues on Saturday night which was very good. It was a whole drama to get it put on, but i'm glad that they did. The Malawi censorship board actually didn't allow it and there was all this protest on social media. Anything related to women is still very taboo here, especially with sensitive issues like rights, violence, and even menstruation! The production was excellent. Sunday we hung out with friends and watched The Wire.

Reflections from across the pond

I am now writing from the Calagary airport as I wait to board my flight back to NYC then off to malawi for last trip during my time off on Monday. I was at a global surgery conference here where it was the first time I presented some parts of my work from Malawi. It was well recieved :) I've been in North America now for 10 days and it's been odd. I kept feeling sad most of the time, even though I was at my best friends wedding ( yes another one!) and found us a really nice apartment ( even though I looked at literally 20) and got to see a few friends for the last time in a whole at least as they are moving out of NYC. The past 2 years off residency have been incredible both personally and professionally. I achieved my dream of doing my MPH and research at Harvard. I got prestigious grants to spend a year working and living in Africa which had been the experience of a lifetime ( the good and the bad but mainly good). I accomplished a lot in research inclusion being published in the lancet and actually made real progress in breast cancer care in Malawi. I was even extended funding to stay another year and really expand my work to make even more impact ( but unfortunately my program wouldn't hold my spot another year). I traveled to 13 different countries and made amazing friends from probably just as many countries. Ben and I had some of our best years yet together where I wasn't working like crazy and we really had time to enjoy each other's company. It's been amazing and so hard to believe that it's almost over in a few weeks and I go back to residency ( first 6 months will be alone without Ben :( ). 

I also didn't realize until this trip how living in Malawi changed some of perspectives. I always used to say I like cities only if they are like NYC or like Europe and otherwise I don't like it. Well Calgary doesn't fit either, but I actually reakky liked it. I stayed with a friend who owns a beautiful condo on a resident salary and says her mortgage was less then her rent for her studio apt in boston. The city is young, hip, modern, and fun. There are lots of great restaurant and entertainment. The hospital is great and it's surrounded by beautiful mountains and a river. It also is just so much more friendly and collegial. The few friends I did see in NYC, of course we went out (except Parisa and her baby Amin). I really love the friends we have in Malawi and how we always hang out at each other's houses taking turn making dinner and just enjoying each other's company. I miss the simplicity and small achievements that make such a big difference in Malawi. Everything feels so rushed and complex and siloed in NYC.  I also didn't  even want to go shopping (something i do normally like to do). It's hard to shop in a store after meeting and supporting an amazing local tailor who made me a beautiful wardrobe from local African fabric at a very low cost.

I guess I sort of went through something similar, a long readjustment when I moved back from Israel. It took several months then and I'm sure it will take at least that long now. On to the next adventure... 

Weekend in the South!

Ben and I have been doing so much traveling outside the country, that we haven't had as much time exploring Malawi, which is a beautiful country in its own right. This past weekend we went down to the south of the country. We stayed in this really nice lodge called Game Haven which has its own non-predator animals. It was really nice and fun and well priced. We then spent an afternoon at the famous huntingdon house where we had lovely afternoon tea and walked around in tea fields.  The next day we went to Zomba, which was beautiful and I mistakenly went on a REAL hike. I did get good exercise and felt like i conquered something, but still didn't find it enjoyable. We had a great lunch at Casa Rosa afterwards.

Last last week in liongwe tonight

ok long time not blog again! sorry! its been busy and fun. Just been trying to enjoy as much of Malawi and friends before I have to go back and Ben stays for another 6 months!

Here are some pics from last week and 2 weekends ago of fun times in Lilongwe...

getting ready for third place in quiz night!

Ben playing soccer at Kumbali

girls night!

my favorite Irish girls!

trying out the new american restuarant

the nachos were pretty good!

dogsitting max and teddy for last time :(

trying out the new Nepalese restaurant and saying bye to one of our British friends

Catching up in Lilongwe

After much travel, we were finally in Lilongwe just working and hanging out. My study finally finished and I was busy with wrapping things up, data analysis, and preparing for my dissemination presentation that went really really well. On Friday Dr. Edge arrived. She is the breast surgeon from Cape Town who created the breast course. We brought it to Lilongwe and now for the past 2 days we had the residential component of the course. The course itself has been going really well. I think the participants are benefiting a lot and really learning. However there were lots of bullshit logistical issues and of course the one thing that i can't stand about Malawi--the ruins of aid--meaning the ridiculous entitlement of allowance, transport, accommodation, meals, etc. I think compromises were reached at the end, but it was a frustrating process. It's been great spending more time with Jenny. Also i had another whirlwind where there was funding available and lots of excitement and support for me to stay another year, but sadly my program couldn't guarantee my spot and its not worth the risk of loosing residency. I am sad to leave and sadly Ben and I will do long distance, but we will survive and it will be good to just hurry up and finish my training so i can go back and be more uesful.

my presentation

me teaching the breast course participants

one of our nice dinners at home--Wednesday night

our fellow farewell dinner friday--Brett and Courtney left

our saturday brunch: the $50 worth of cheese i bought in London and the pellegrino i brought from the U.S. finally opened

saturday night dinner at Brenden and Davidai's

Ben playing soccer on his new team 

HIFA

after being back in Lilongwe for about 24 hours (which included seeing my study being finished--woohoo) Ben and I were off to Harare for the Harare International Festival of Arts (HIFA). We were so impressed with both the parts of Harare we saw and the festival. HIFA was very well organized with a wide variety of performances including theatre, dance, poetry, music, fashion, and fine arts. We stayed at the crowne plaza right where the main venue was at the Harare gardens so it was nice and easy to get around. We had some good meals out too! as well as in the gardens!

downtown HIFA!

a fashion show

one of the many upcycle awesome projects we saw

the Zimbabwe National Gallery--some really nice peices

Ben and I having lunch at the gallery

an amazing pianist: Kyle Shepherd

nice dinner out-Emmanuel's

the main gate to HIFA

London

ok, long time no blog...its been a very crazy past few weeks, but also mostly fun!

On April 26 I was off to London for the launch of the Lancet Commission on Global Surgery. Its been 18 months in the making and quite a fun journey. I was in London for a really short period of time--3 days and it took almost 2 days each way to travel. I've always loved London, but this time i realized how much i really love London. The one day I had to just hang out, all we did was walk and eat! The conference itself was pretty good. It was good to see people I haven't in a while and met some really great new people as well.

starting the day right with amazing shakshuka made by Gabe

the amazing Columbia Flower market

my heaven: amazing cheese shop

delicious brunch with my hosts Julie and Gabe

couldn't get enough cheese, after lunch and hunter boot shopping went back to cheese shop for wine and cheese

the lego floor at Hamleys: a phone and phone booth made of legos!

my CSPH mentor Robert and friend Shilpa-aka Team Rwanda

my Malawi surgery friends