A Day in our Life: I'm Glad there's Two of Us

6:30 I get up, brew tea, read my Bible, eat breakfast, and get ready. Greg’s awake by 7:00 and I ask him to help with the printer. I wanted to have vaccination cards, visit forms, and safety brochures available for my patients this morning, but the printer wasn’t cooperating. Greg gets it worked out and by 7:20 we’re out the door.

7:32 Greg drops me off at ABC clinic for devotions, then handover, then some patient visits. He goes to pick up concrete and lumber to help with some improvements around the house. Our back wall needs repairing, and in Malawi, when you need a ladder, it’s much easier to make it out of lumber than to buy one directly.

8:50 Greg came home and had a few minutes to rest before Hamiton and Lighton arrive. Hamiton worked for us on some projects over the last few years, and has been out of work since, so we invited him to stay with us for a week and work on our to-do list. Mr. Lighton usually guards our house at night, but he’s so handy with wood and concrete that we asked if he was willing to come during days to work with Himiton. Greg walks around with the guys and talks about where fences need to go up and ideas for rain-proofing and mosquito-proofing.

9:00 I’ve started my first visit. Today I’m seeing a 4-month old and a 6-month old. It can be hard reconciling immunizations for families living between different countries. The four month will skip the PCV vaccine until her 6-month visit to stay consistent with Irish guidelines. The six month old will received an extra MMR and Hepatitis A vaccine, given by our amazing charge nurse Victoria. The mother brought the extra vaccines in a cooler, which was left behind and we’ll have to arrange for a pickup soon.

10:20 Our gardener Golden arrives with his wife Mercy. We’ve never met her before, but wanted to take a chance to help mentor her as she is thinking of moving forward with some business ideas. Greg locked up the dogs and set out a coke and biscuits. I had a basket of tea ready by the door, but the day was warming up enough that a cold drink was better.

10:40 Thoko and Nixon drive up. They ran out of gas on the way because the gauge in their car wasn’t working, but they are just on time for our busy schedule. Thoko joins Mercy at the outdoor table and starts talking about logistics of a clothing business, the cost of importing from Zambia and the market in Mercy’s neighborhood. Greg grabs Nixon and drives off to the hardware store again.

11:30 I finished with my patients – it’s a short day. Greg picks me up at the clinic and drives me home. Greg and Nixon have been to pick up pipes which should finalize the solar pump in Mngwangwa. Thoko plans to plant tomatoes soon to earn some extra income. Back home, Thoko and Mercy have finalized a business plan for fabric imports, and realized that the profit margin is less than desirable. We spend the next hour troubleshooting other ideas. Golden sits in and helps with the logistics. He says that he will help his wife in the afternoon, when he is finished with his work at our house. We find that buying used children’s clothes has a better profit margin. We discuss record keeping. I let the group know that I still need to discuss with Greg, but it is possible that we will help invest in this business if they can start by procuring a safe themselves, so the money will be secure. Thoko and I pray for the business, we both know how hard it can be to begin a business in

Malawi.

12:00 Greg and Nixon head back out. After a stop for gas, they go to Nathenje Church of the Nazarene. Our friend helped build the bore hole here, and wanted some pictures and testimonies. Greg brought his drone and took some areal views, and became an instant hit among the village children. By 1:00 they were heading back, planning to stop at our favorite fried chicken place for lunch, they have great Monday specials.

1:30 Golden returns with some lunch dishes from a restaurant in our neighborhood, rice for the ladies, nsima for the guys. I encourage him to eat lunch with Mercy and show her the projects he has completed around the house. Thoko and I sit inside and talk about next steps in her village – tailoring, agriculture, a poultry project, and a reforestation project. She jokes that this is the first time in a while that I haven’t tried to make her eat veggies when she comes to visit. So I get up and make her a salad.

2:10 Greg comes back, followed in the gate by Richard the mechanic and then Ben, a newly arrived missionary with the CHSC. Ben drove to our house yesterday and encountered brake trouble, so he left the car here until Richard could check it out. I’m not clear what they did, but I know there were various trips inside for screwdrivers and assorted other tools. Somewhere about then I am asked to see the rash on Mercy’s toes, an easy enough issue, I prescribe a cream. I ask Thoko to pray for her, because I always try to pray after seeing a patient, but I prayed last time and Thoko is well-known for her healing prayers.

3:00 Nixon has had a painful neck spasm, a condition his wife and daughter are teasing him for. I print out a “work restriction” sheet for him, mostly for fun but also to give a bit of official backing to his need for rest. No long cell phone calls in the next 2 days, no heavy lifting for a week. He’s been having some relief with a heat pack, and I send him home with a couple creams.

3:15 At this point Greg and I are standing in the garden as Lighton and Hamiton hold up a six-foot by six-foot trellis. We all decide together where to put it – turns out we like the corner of the running path best, between the two new flower beds. We discuss ways to anchor and stabilize this archway, then check the time and realize we have to bid our guests goodbye and rush off.

3:40 We’re 10 minutes late to an academic forum with one of the most prominent political historians in Malawi. The event is hosted at our friend’s bookstore and so well-attended that Greg and I sit outside. I can use the fresh air anyway, though I might have done without the extra sun.

5:00 At the end of the event, I browse books and decide I want to read them all. I think I need to work on the ones currently in my shelves first, though. I talk to a friend about the yoga class she attends and invite her over to try some of my new tea. We head out, stopping to see the garden fountain outside the shop, and I dream about whether I can manage making a fish pond like that.

5:30 Back home. We greet the dogs, turn on the lights, and settle into the couch. It has been a long day – good and productive, but a bit exhausting. Thinking this will be a night of reading and going to bed early. Not even going to check my e-mail…

Patient care through Hallway Consults and Prayer

I drew in a deep breath as I considered my patient’s test results, wondering how I would explain them to her. These were the type of results that showed something was wrong, but not exactly what or how dangerous it was. This woman thought she lost her pregnancy months ago, but now she was bleeding every day and experiencing significant pain. The test results showed that her body still had hormones related to pregnancy, but the ultrasound didn’t show anything in her womb. There were a number of things that could cause this situation, and none of them were good. I had prayed that these tests would show me what was happening for this patient, and I guessed they told me just enough to move forwards. I stepped into the hallway, hoping to find someone to discuss the possible next steps before I brought the news to my patient.

I praised God that Alice was available in the room next to me, and Veronica had just finished seeing her patient two doors down. As these women joined me in the hallway, I breathed a sigh of relief. Alice and Vero are Malawian Clinical Officers with about four years of formal medical training after high school. They’ve been caring for pregnant patients at ABC clinic for years, and they can perform C-sections and difficult deliveries that I would never attempt as a specialist in Family Medicine. Fortunately, they understand that I’m newly back and needing their advice, especially when it comes to caring for pregnant patients. So I told them the patient’s story and the test results, the conditions I was worried about and the next steps I was considering. They thought of some questions I had forgotten to ask and confirmed my suspicion that we needed one more test to help us know whether the patient needed surgery today or tomorrow. Alice offered to see the patient with me in her room while we waited for the final results. That was an incredible help because my room didn’t have the equipment for a pelvic exam.

With steps of renewed confidence, I started down the hall to find the patient. I found her outside, sitting on the grass with her sister. Apparently the pain medication I gave her had helped the pain but made her feel chills. I sat beside her, squinting in the sun, and began my explanation. I was reassuring but honest, trying to share what we knew and what we didn’t in ways that were understandable but specific. I wanted to convey the seriousness of her condition without being alarming, to involve her sister in the progress of the diagnosis without revealing any of the specifics the patient had told me in confidence when we were alone together. It was good because we were starting to understand what was wrong, I said, and it was good that she came today because this could have been dangerous if she waited even a little while more. We still needed another blood test and an exam to know for sure, but I warned her that she would probably need a surgery to recover fully.

By mid-afternoon, it was clear that this patient would need a surgery. Fortunately, she was stable enough to wait until the next day, when a full team of providers could help her. After confirming details of the planned procedure with Alice, I explained next steps to the patient and sent her off with a prayer. I thanked God that she had come that first day she had pain, and that I had some cancellations in my schedule allowing me to spend over an hour getting to the bottom of her problem. Even as I drove home that evening I carried thoughts of her in my heart. She is going to need healing physically and emotionally and probably spiritually also in the weeks that come. I pray that I can be a part of that healing process.

This month, please pray for the patients and team at ABC Clinic. Please pray for Greg as he prepares for teaching another semester at NTCCA. Please pray for safety for us as we await our second COVID19 vaccine. And please pray for the country of Malawi as a whole.

Shadowing

Yesterday was Susie’s last day shadowing me at ABC Clinic. Sometimes she really was like my shadow, quietly observing my conversations and treatment courses with patients and taking notes of her questions to ask me after they left. But most of the time she was more like my second self, running down the hallway to get something for a patient, or keeping a patient company in the room as I rushed around collecting items and information. She’s seen me at my strongest, diagnosing a patient based on a few lines of history or a couple taps to the elbow. She’s also seen me at my worst, like last week as I unsuccessfully struggled to contain my stress that time we were late and lost on progressively narrowing dirt roads on the way to our village outreach. Or the time a few weeks ago where I sat on the floor and kicked up my heels, throwing an exaggerated temper tantrum as an intentional demonstration that neither missionaries nor doctors were exactly perfect.

Working with a student, or any learner-observer, gives me a chance to examine my life. When I am trying to mentor someone and explain my actions to them both in the clinic and beyond, it makes me think about where I am, what I am doing, and the reason behind my actions with renewed intentionality. Often, when I interacted with Susie, I thought about what I was like as a pre-med student a dozen years ago. As we discussed everything from work-life balance to logistics of praying with patient, I tell Susie my life lessons, things I’ve learned during the different phases of my training, and things I wish I had learned sooner. I wonder how my life would have been different if I realized some concepts of boundaries and balance earlier. Most likely, I wouldn’t have listened to myself. But at least Susie seems to be processing, and growing.

Having Susie around gave me the energy to start an improvement project in the clinic. We discussed areas that were concerning clinic leadership and decided to try measuring how long patients spent at the clinic each day. With the help of Susie and some amazing front and back office staff, we went from not knowing when any patients left to having leave times of 50% of patients and then 80% of patients. We introduced some forms and adjusted some processes so that we could track which patients waited the longest and why. Then we looked into some areas of improvement. After Susie and I gave our first report to Administration showing that some delays were due to waits for drawing blood and taking it to the lab, we were shocked that clinic leadership already had a suggested improvement in mind and ready to implement. In just a couple weeks, everything was streamlined, and the steps causing delay were cut out of patient processes. I made sure to tell Susie that usually Quality Improvement is not that easy. But it was fun to see the results of our efforts. Much like the afternoon we re-wrote a white board for the clinic, it was a great visual of how quickly things could improve with good teamwork and leadership support.

I was amazed that the white board that I bought to help our small team plan lunch breaks in 2017 was still in use in 2021, and a little horrified the condition it was in, hanging on an otherwise pristine wall. Greg helped us remove a thin film of plastic (had we kept on the manufacturer’s plastic covering and used the board improperly for 5 years?). Susie, who had much better handwriting than me, helped write the names of current clinicians and the days of the week each was available. It was amazing how our little team of doctors had expanded in the past years. Amazing that patients were still keeping us all busy. Refreshing to see something so dramatically improved in such a short amount of time.

We definitely appreciated Susie. We appreciated her all the more when she surprised us with a cake to celebrate Greg’s birthday yesterday. It’s weird to think that we had never heard of her two months ago, before she cold-contacted the ABC clinic e-mail from her position as a volunteer at Northwest Mission. We will miss Susie, for sure, but we’ll look forward to hearing about her journey and supporting her as she goes. And we will look forward to other divine appointments in the future, people who will help us grow even as we try to mentor them.