Teaching about Cholera with Plastic Bottles

“When someone has cholera, they start losing all the water in their body. They can’t drink water fast enough to keep up with how much they are losing.” Thokozani works with me to create a visual using a plastic bottle with a hole in the bottom. Pastor Nixon helped us make a hole in the bottle earlier, and the knife he used was so big that the bottom was now missing from the bottle. Sure enough, when Thoko poured water into the bottomless bottle, it poured straight through.

“If you use oral rehydration solution instead of water, then the electrolytes help keep the fluid in the body.” Now, we pour the water in, but I keep my hand over the hole in the bottle. A bit still drips around, but the concept is there – the loss of fluid has slowed and the “body” gets a chance to fill back up with water.

We’ve tried to teach about oral rehydration (ORS) in this church before, but it’s hard to talk about the exact amount of salt and sugar to add to water when nobody has teaspoons or tablespoons. Today, we told everyone to bring their own water bottles. We divide them up into groups of ten, and the leaders come up to get portions of salt and sugar to bring to their groups. We realize that filling a plastic bottle cap is almost exactly a teaspoon, and each leader sees for themselves how level their cap looks compared to a teaspoon. Three teaspoons sugar and a quarter teaspoon salt – that’s the amount of electrolyte to add to a 500 ml bottle to make ORS. Years ago, we tried to explain that the recipe used just a pinch of salt, smaller than your pinkie nail. This year, we realize that the amount is equivalent to the inside ring on the plastic water bottle cap. Again, all the leaders measure their bottle caps against the quarter teaspoon measurement and bring the quantities back to their groups.

Everyone looks at the color of the ORS in the bottles and tastes the flavor so that they can compare it in the future. We use the water bottle to share about how much someone should drink if they have cholera. Adults can drink the full bottle each hour, children can have up to the halfway point. Thokozani and I go between groups and answer questions: Can someone drink ORS if they are not sick? How much should a 12-year old drink? Can you use chlorinated water to make ORS? These are good questions and the groups are thinking through together how they will use this electrolyte solution to help people with various gastrointestinal diseases.

At the end of the training, we hand out smaller bottles of water purifier. We explain that these bottles will only purify 600 liters each, and that they will have to work with their churches and communities to purify water after they run out. The local community health worker wasn’t able to attend this meeting, but he told us to remind the people to ask him if they had concerns about chlorine. Different purification solutions used different amounts, and a village member had died recently when he drank undiluted chlorine trying to cure himself from cholera.

Already this group is making plans to help a visually impaired woman to purify her water. Groups coming from different villages are discussing the future together. They have their bottles of ORS and their chlorine to take back to their villages. They take extra attention to wash their hands before they sit down to lunch. We close in prayer, asking for protection from illness, strength for our bodies, and wisdom to help our communities during this difficult time.

Cyclone Freddy Update

Many people have been contacting us to see if we have been ok amidst the cyclone hitting Malawi. We wanted to write a quick update to let everyone know that Christina and I and in fact the area of Malawi we are in are doing alright. Our area, the central region, is not getting hit directly by the storm, the worst we are experiencing is lack of power and running water, but even those we may get a couple hours during a 24 period. Enough to keep things running even for those of us who are used to such comforts.

As for the southern part of the country, the same can not be said. If you have heard about the cyclone on the news, in some ways you have heard possibly more than we have, since internet and communications have not been great in the country recently. But we do have friends whose families are being affected, and we are being told that even the main city in the southern region, Blantyre, is experiencing flooding.

The storm, Freddie, turned from Malawi back into the ocean yesterday, so it seems like the worst of it is over, but many roads, homes and infrastructure have been damaged. 22,000 have evacuated, 200+ have lost their lives, and the country has been without power for the week. It is only now that people are starting to understand the total extent of the storm.

We have also received some inquiries about how to help. For those who are interested in this, we would recommend giving to one of two organizations who are working with restoration and care in the regions affected. We can connect you with some options from organizations we respect. See at the end of this post for more on info.

If you have given to us recently and would like a portion of your donation to go towards cyclone relief in Malawi, please let us know. In many cases we do have ministry funds in reserve for emergencies like this.

In terms of prayer, please pray for the people of Malawi, for those already impacted and for those who will continue to be impacted in the future. Please pray that the country will miraculously not suffer from worsened cholera or food insecurity after all of this, and for healing in the days to come.

As for us, we are doing well. We hope to go to Mngwangwa village tomorrow and teach a group of women from many churches about how to prevent and care for cholera. We are hoping to investigate the borehole they use for clean water, to see if we can help repair it, and also to distribute some chlorine to help sanitize water. Please pray that the teaching will go well, that it will enhance health and healing, and that we will be able to travel safely there and back.

Thank you for your care and support,

Greg and Christina

More info on helping with relief:

World Renew is a relief and development Christian organization which will be helping with the cyclone relief. At the moment their website does not have a link to give to the cyclone directly, but if you mention Cyclone Freddie, or malawi it will make it will be set aside for that purpose.

https://worldrenew.net/

Also, we received the attached pdf from a missionary doctor and friend of ours who is working in the area affected has sent out a request for prayers and donations.

A Trio of Reflections on Balance and Wellbeing

2.20.2023

Physician Wellbeing

I wore my blue physician wellbeing shirt today, a reminder to rest and take things easy. It was a 3-day weekend in America, not a holiday here in Malawi, but I wanted to take some time to release some stress and relax and work less anyway. Work has been going well, patients are recovering or at least progressing, and the work I am helping with in America has some incredible opportunities and projects coming up. But I wasn’t doing well with boundaries. I tried to take last Monday easy but I ended up working just over 8 hours. By Wednesday I was pulling almost 10 hour days and by Friday I had logged 13 hours, starting at 9 am and not finishing until after 10 pm, with barely a break in between. I was loving my work, it really rejuvenates and motivates me. Well, at least until the end of the day when it was time to sleep and I still just can’t let go, always trying to do one more thing. And the work had also extended into the weekend; I found myself sitting in the office checking just one more email, planning one more thing. Greg had to come looking for me, I had left to go to the kitchen for dessert but found myself in front of the computer.

So now I sit on the couch and listen to a meditation about trusting God, while cuddling with my dog. People think I have good boundaries, probably because I only check my emails at certain times, I tend to leave my phone on silent in a corner of the house when I don’t want to be disturbed, and I’m only going into clinic to see patients in-person a couple days a week these days. Yet somehow I’m busy with emails and phone calls and projects all day most days. I try to take a day of rest at least once a week. Sunday was pretty good yesterday, with no official work, but I was trying for another restful day today, partly to make up for the 55 hour workweek last week.

So I wear my blue shirt and after cuddling with my dog I drink tea. Greg schedules a massage. That’s right, a massage. At $15 per hour I try to book one every month. Even at that frequency, I can feel the muscles on my back like a rope made of knots, slipping and sliding as the muscles try to give way. Today, I spent a little extra on a hot stone massage, and the combination of pressure and warmth finally get through some of the tension. For once my masseuse doesn’t chide me for having so many knots, maybe she feels like she has told me enough that I should come in more often, and I never do. Sometimes I wonder if my back would be better if I knew how to relax my muscles – I think I learned to exercise them and stretch them, but never really how to release. I do leave the parlor feeling relaxed, more so than I have in a long time.

Greg and I grab some food on the way home, some ready-made chicken from the supermarket. I read a book on the couch and later, in the garden. The weather is so nice today and I notice how the birdsong changes to crickets as the sun starts to set. Then I move into the screened porch because neither my dog nor I like the mosquitos that start coming out at twilight. I reflect, I plan, I read some more, I meditate on scripture, I listen to praise songs. I cave in and work a little bit. Just a little – reading through some things so that I can start thinking about big-picture ways to write articles and send in reports and take next steps. I drink lots of water and tea and eat lots of veggies.

I need days like this, I think I might be even more productive this week because of the rest today. We shall see. Step one will probably be getting to bed on time, that will be a first in a while.

2.22.2023

Out of Balance?

You would think a doctor would understand her body more. I mean, that’s definitely what I would think, what I want my patients to think. And yet I sit here, trying to rest, and I notice that my right bicep is twitching, and I don’t know why. It started a couple days ago, and it usually calms down if I touch it gently. But today the left bicep started twitching too. I stretch, walk, exercise, eat healthy, I’ve even been sleeping like I should, mostly, I just can’t understand why my body would do this. I rationalize: well, this is some of the first time that I’ve tried to be intentional about rest. Sure, I’m still working 8 hours a day, well, not yesterday or last week, when I had zoom meetings and didn’t finish until after 10 pm, but I have taken extra days off to compensate. One of my friends laughed at me when I announced that I would be trying to stick to 40 hours of work a week in honor of this being my seventh, my sabbatical year. I thought she was laughing because she, a surgeon, thought that 40 hours a week was unrealistically low for any doctor. I realize now that maybe she was laughing because 40 hours a week isn’t much of a break.

I worked closer to 60 hours last week. But I took Monday off to compensate. Maybe that’s the reason, I rationalize, my mind and body just don’t know what to do with rest after intensity. I think about it intellectually, too. I have a patient booked tomorrow, a middle aged women with a condition where she can’t control the impulses in her brain. She says words she doesn’t want to and can’t stand on her own feet, and all the tests show that it is coming from her brain, not her muscles. Instead of controlling her nerves, her nerves are controlling her. So I think, maybe this will help me to better understand my patient. Then I wonder, is this part of the restless leg syndrome and Parkisonian traits that run in my family? A friend messaged me recently and asked, with as much as I’ve been sick lately, if I’ve seen a doctor. What should I do if I’m reasonably convinced that another doctor wouldn’t have a solution any more than I do?

Then I think it could all be emotional. This morning a dear friend of mine told me that she was being summoned to the medical council next month after an adverse event in the hospital. I know the hospital, and I know this doctor, and I am certain that there were other factors which led to the death. If anything, my friend was the one trying to hold everything together and sound the alarm. And now I’m afraid she would be a scape goat for an institution that she has been trying to help hold together for years. Maybe my feelings of dread for her and helplessness are part of what is making my brain feel fuzzy. And it’s not just that, Cholera is killing people in this country and it shouldn’t be. It’s so easy to prevent and easy enough to treat, if people come in on time. But some churches say that Christians shouldn’t worry about infectious disease and culturally some people don’t like drinking treated water and economically they can’t afford to boil or filter all their water, so people get sick, and people die. Then sometimes villagers come and attach the cholera units where their family member died. They riot and burn tires and threaten the hospital staff, a reminder why usually only certified government hospitals and foreign volunteers from the outside are the ones working in cholera units. I wish I could do more, but I don’t know where to start.

So maybe that’s why I stay up late helping my friends in the US with their training programs and their public health initiatives. Things are making progress there, and I’m the one who gets to tally up the results and show how smoothly things are running. Residents and students want to join us and people barely notice that I’m working remotely from sub-Saharan Africa. So maybe that’s why I stay up late, because there is a rush of satisfaction from the work I do at nights. That’s also why I try to work less and put up more boundaries, so that there is more of me left at the end. So that I can think about long term goals here and not just the path of least resistance there. It still doesn’t explain why my biceps are twitching, but at least it’s not constant like the right eye twitch I lived with for 10 months last year. Maybe I’ll stretch and go for a walk in the beautiful weather outside. Maybe I’ll sit and reflect a bit more before jumping back into work.

2.28.23

Striving to work less.

I’ve never tried so hard to be intentional about taking days off, taking breaks during the day, and getting rest. Well, I’ve never tried for so long to set boundaries on myself and make up for overworking. Yet somehow I still overwork – a call from a friend means I need to go in and see a sick old lady in the morning, and then meetings about maternal health and wellbeing research in Loma Linda extend late into the night, past 10:00 night after night. My holidays and intentional days off seem to evaporate when balanced with 11, 12, and 13 hour days. I work through dinner, I work through lunch, I try to get a few more emails in during the morning before Greg wakes up. Work is exciting right now, rewarding, definitely, but also demanding.

Last week I got sick again. A GI bug this time. I felt nauseous one day and was completely emptying my stomach the next. It wasn’t cholera, thank goodness (we haven’t had a chance to update our vaccines because the country ran out of vaccinations, but praise God we have been OK for now). But I was tired and couldn’t eat. I was impressed at what I could drink, though. Before lunch I had taken down 3 liters of Oral rehydration solution – a fancy name for mixing salt and sugar in my water. I was tired, for sure. Thoko and Nixon came to visit and talk about next steps in village outreaches, and by the time they left I ended up taking a 3 hour nap – it’s been a long time since I slept that much during the day and still had time to rest at night. And within another day I was feeling better – back to running, back to eating, back to drinking regular water without sugar and salt.

But I continue to ask myself, how is it that I have had so much sickness in these few weeks which I’ve tried so hard to be intentional about resting? I joked with my sister that maybe my body is a lump of tension held together by stress, and attempts to release stress do a bit to unravel me. On the other hand, perhaps this is the first time I’ve tried to have intentionality about rest in 20 years. Never since high school, maybe even junior high, have I tried to find rhythms of rest week after week, month after month. I can’t say how well it is going. I did go on a vacation and I did take some days off this month. But then I worked more than 10 hours a day on the remaining workdays. Sometimes I wonder whether it’s good that I’m aware and trying hard to fix my workaholic habits. Other times I worry if keeping track of everything and trying so hard is adding to my stress.

Friday is a national holiday this week. I don’t think I can take it off from work, I have a meeting at 7 pm. I was still trying to decide whether or not to attend the meeting at 11pm. Now I see that there is one