Ashes to Ashes

Whilst it is not the most cheerful topic to write about one cannot spend a year living in Malawi and not talk about death, dying and funerals! The reason for this is that death is very much a part of life here in Mzuzu. This has been highlighted to me on a very raw level today when I was teaching and working with one of my first year students on the female medical ward.
Those who have read this blog before know that hospitals here are not equipped, stocked or staffed with anywhere near the resources that we have in, what I still believe to be a good old NHS hospital. The result of this is unfortunately people dying of causes that can and would be treated and avoided in other parts of the world. The incident to which I refer today was one that could have also potentially been prevented here in Malawi with the availability of a simple piece of equipment called a nasopharyngeal airway (a tube we put up peoples noses so that we can then suction fluid and sputum off their chests and clear their airways, essentially it’s like hovering someone’s lungs!). This was not available though and unfortunately the lady had what would be classified as a respiratory arrest at home and died as a result, much to the distress of my first year student.
When I compare this situation to the commotion and sense of emergency that would have existed in the same case in the UK it was really a very surreal situation for me and one in which I felt rather helpless and almost at a complete loss. Knowing that there are actions that can be taken but which one cannot take because there is not the resource is not an easy position to be in. But I learnt today that this must be how the trained doctors and nurses in hospitals all over the developing world must feel on a daily basis; having the knowledge to treat and cure but not always being able to maintain life because, in some cases it could be argued, a government has failed to provide the resources necessary to do so.
Death here, like all over the world, means performing last offices and being a nurse I have unfortunately done this a few times in my life so I am well used to the dead body. What I have never witnessed was what occurred once the body was ready to be taken off the ward. There was no screening the other patients of the body being removed from the ward, the patients and guardians were all up on their feet and as we led the body out to the nurse’s station there was a very distinct sound emerging that I can only associate with death, the wails of the relatives who lost their loved ones as they fell to the ground in grief. There was then a starting up of communal wails from all the other women present before a male visitor led a prayer and the body was wheeled by the nurses to the mortuary. As we wheeled the body out of the ward a procession of wailing women, which grew in size as we moved through the hospital, followed. Only after the body was deposited in the fridge of the mortuary did the wailing cease. The group did not disperse until we wheeled the empty trolley back to the ward.
I think this very explicit display of grief is common the world over and it is something I feel we suppress in our hospitals at home in those communities for whom this is an expression of their loss. This emotion though is not evident at the funeral (or it wasn’t at the funeral I attended). Here in Malawi funerals are attended by anyone even if you had no personal connection to them at all. Churches or burial sites are full of people some who come and chat throughout a service but who will follow a coffin to the final resting place. Whole communities are present and I now know that when a see lorries full of women in black and white singing they have been burying someone.
Whilst we do not acknowledge death openly at home, it is ever present here. Barely a week will go by without a colleague being away from work to be present at a funeral and this is the expected course of action for one to take. Whether this is right or wrong I am in no position to comment, it is for me just different. But I know while I am here I will witness many more deaths a lot of which could be preventable but like my Malawian friends I will learn to be pragmatic and open about it as I think I can see this is the only way to survive.