A Day in My Life, April 2021

I woke up at 6:00, just right because I went to bed early last night

By 8:00 I’ve had some cups of tea, breakfast with Greg, jogging with the dogs, stretching, prayer time, and a core workout. Told some family members and friends that I was thinking of them. Greg and I divide up tasks for the day over a final cup of tea. He’s contacting people and making copies for the agricultural training with pastors in Goshen Zone this week. I’m working from home.

10:30 Mondays are my day to work on projects for the American College of Lifestyle Medicine. I’ve incorporated feedback and nearly-finalized a module introducing the role of lifestyle in chronic disease management. This module might help familiarize all sorts of people with the healing that Lifestyle Medicine can offer. The work might also help pay the rent in our incredible house all year. I only meant to work for an hour at first, but it’s hard to pull myself away.

11:00 I walk around the garden with Golden and discuss ideas for composting, replenishing soil in eroded patches of the yard, and building a jogging trail. I sip an iced tea as I check my phone. New plans formulate to assist an Nkhoma Family Medicine resident in a publication sharing how we’ve assisted a rural clinic with chronic disease management. Maybe we’ll present on this at the American Academy of Family Physicians Global Health Symposium next fall.

12:00 Time for some smaller projects. I snack on freshly cut veggies as I communicate with Roberta about a time to talk about how we might collaborate in helping refugees. I e-mail one patient about her muscle spasms and medication interactions and another about plans for her child’s Mumps vaccination. I tell one patient I am excited to see her in the office tomorrow to discuss “another issue.” That reminds me about some patients who said they would see me about sensitive issues in mental health and reproduction. They haven’t booked yet, so I’ll check in with them and encourage them about that. I check in with some church ladies back home who have been praying for us, thanking them for their prayers and letting them know that I’ll be praying for the new requests they sent over.

1:30 Lunchtime. Greg brought home some protein to top our salad. We ate most of our lettuce yesterday so I pick some extra greens from the garden on the side of our house. We briefly enjoy the sunshine on our porch and divide up tasks for the rest of the day.

2:30 Back to work. Exploring best-practice lifestyle guidelines and evidence-based research this time. Greg goes to pick up printed handouts for Wednesday.

4:00 Break for hummus and carrots. Greg finally connects with the trainer, trying to set up a time to meet tomorrow. We connect him with the pastors. Then back to work for just a few final things.

5:00 Running with the dogs around the neighborhood before it gets dark. Enjoyed watching the rise of a beautiful Supermoon on a background of pink and purple as I turned sequential 1 km laps. We greet our guard Mr. Lighton and ask him to water a bit tonight.

6:30 dinner break, Greg made leftovers. We eat in 12 minutes. I check my e-mail, send off some quick feedback to another doctor who might collaborate with me for a presentation at the Global Health Symposium next fall. Moving forward nicely.

7:00 Very productive Zoom meeting. I have enough additional things to work on to keep me busy for a while. I have to trust that I’ll remember them by tomorrow, otherwise I’ll never get to sleep.

8:30 Check e-mail again. The patient with muscle spasms has booked to see me soon after the “another issue” patient starts her appointment. I advise that I will do my best to go quickly but might be late. I put my spare nerve stimulation unit on the desk by my doctors bag so I can loan it out to her if necessary. I thought of adding my tub of sore muscle cream to the bag. On second thought, mine is already opened and I need that for myself… Review a contract for this work I’m doing. Send off an e-mail to negotiate for more time due to delays already incurred.

8:45 Computer abandoned in office, check phone. Decide to call a family member. Really enjoyed that, but sending a follow up e-mail afterward took a bit longer than expected.

Tea and Community

For the last four months, I have enjoyed participating in an online tea community. I sipped and discussed a different tea daily with hundreds of others. We shared photos and prayer requests, tea reviews and daily anecdotes. There were even options to chat together on Friday, which worked a few times depending on time change and internet capacity. Individuals I knew only virtually sent me birthday and anniversary wishes. Some even sent me samples of tea using their online rewards points. It was so enjoyable having something to look forward to each day. Some might have said that I was a bit too involved, carrying tea bags around with me along beaches in Hawaii and on safaris in Africa. Others discovered the community and are enjoying it themselves after I used my rewards points to give them a free gift.

Although I will miss the excitement of a new tea every day, I will also enjoy the chance to drink down some of the teas I already have, and to blend some of my own teas. Today I tried a raspberry chocolate cream Ceylon blend and a blackberry maple vanilla oolong blend. I enjoyed some afternoon boba tea and some evening herbal tea. We had friends over for iced tea on Saturday, and tomorrow I’m having a virtual tea date with my mom followed by a friend visiting for tea. It will be nice to turn the virtual tea parties into real-life tea parties on my veranda.

But even more than tea at my own home, I’m excited about the village teahouse that Thokozani is about to open. We were with her years ago when she purchased the land and building for her teahouse. We waited two planting seasons as she suffered a loss of inventory from her clothing shop and focused on other community improvements. But now, this week, it’s happening. She’s buying up 50 pounds of sugar and even more milk powder and opening her teahouse right in time for to serve people coming back from harvesting in their fields. At 50 cents for a small cup and 75 cents for a big cup, she’s underselling the tea shops a bit down the road and hoping for hundreds of customers in the first week. She’s already thinking of buying some land to plant trees so that her patrons can enjoy the shade as they relax at her teahouse. I had a sample of her tea service this week as we were in the village assisting with agricultural training. Sweet and creamy, it was a great cup of tea that really made me feel pampered. She piloted making tea for 30 people each day during the training, giving each person a half-loaf of bread to go with the tea in truly Malawian style.

She plans to use part of the teahouse proceeds to support local children and local women’s finance groups. That woman is amazing and it is amazing to watch and sometimes participate in her enterprising spirit and community development. I can’t wait to have a cup of tea in her new teahouse.

Refugee Camp

She sat in the dirt in the small, dark room. Her face bright, she sang from a tiny Swahili hymn book. I learned my first words of Swahili that day – Thank You and Hello – I haven’t heard Swahili much in Malawi, but here in Zaleka Refugee Camp, the Chichewa that I know does not carry me very far. This woman is 65 and her name means Joy. She seems to live out joy in spite of her circumstances. The wheelchair in the corner and her legs crumpled beneath her skirt speak of a lifetime of disability, probably from late-childhood polio. And that’s just the beginning of her struggles. She feels weak, her heart beats fast, and it all seems to be linked to anemia from three-times-too-low hemoglobin, which in turn is due to dietary deficiencies. Most individuals in the refugee camp get a ration of porridge daily, but she relies on others to help her with cooking and preparing food. Today she has a gift of sweet potato greens from a friend, but she doesn’t get nutritious foods often, and she doesn’t have the strength to care for a garden. There isn’t much land in the refugee camp, anyway. Some people rent fields from the surrounding areas, but the camp itself is a food desert, a slum covered in dry earth, out of place in the midst of Malawi’s fertile green season. I see green all around, except here. Every road in the country is dotted with people selling crops of fresh vegetables, but here there are just a handful of half-rotten tomatoes on display on a few corners.

She’s been treated for parasites and told to take iron. Some years ago, when a program gave a handful of beans every day, her anemia was only half as bad. But now there are no beans. It’s difficult to problem-solve in a context like this. It’s hard to use local resources to solve a community’s problems when a community is artificially held in a setting with few resources. These people build houses with their own hands and educate their children in schools they manage themselves. They have vibrant churches and prayer outreaches and truly care for one another. But they can only farm if they rent land outside the camp from Malawian landlords. There’s not enough food, and it’s not nutritious. A family can use an entire liter of oil each week simply because their only other source of calories is cornmeal. And they are not legally permitted to take jobs, but can be sent to prison if they try to find income outside of the camp.

I recently reviewed a grant application to bring nutritious foods to underserved patients in Arizona. How much more do these people need a transformative program? I’ve been working to develop healthier resources for Lifestyle Medicine, but how can a community start when they can’t source fresh foods? I’ve been enjoying seeing patients in Lilongwe this week, but what can I do for patients whose nearest clinic has no medication? I saw a sick infant diagnosed with Malaria, who continued to get sicker because no malaria medication was given. Was it a language issue at the clinic, or the pharmacy was out of medicine? And then there’s this woman, Joy. A brief touch of my hand shows that her right sided pain is from her gallbladder. But what can we do about that? She can’t afford a scan, much less a surgery. So far, she can’t even manage to improve her diet. What can we do for a people like this? What should we do? For now, we’re praying. We do have some resources, we do have some training and expertise. We might not be able to catalyze development in this context, but we could probably bring some relief. Should we do that now? How can we be wise, and help without causing more harm to this community that has already been through so much?