Unique Patient Encounters

I’ve been caring for patients in creative ways during the past weeks, as I finalize logistics to start working in Lilongwe again. I follow up with patient questions via e-mail, like usual, but having time on my hands for the first time since we moved to Malawi has opened up some opportunities for care that were not possible before. One day I had a 1-hour zoom conversation with a patient suffering some unusual pains. I know telemedicine is pretty common for doctors worldwide these days, but a face-to-face visit with a patient on the other side of the country was new for me. Earlier that day, a family came to visit us at our house. The wife is a talented tailor who came dancing in wearing a colored dress cut from the same cloth of the curtains she just delivered. Then she brought her daughter from the car and laid her on our couch. The seventeen-year-old had been in pain for some time; she had a long-term problem that I knew about and a few other problems that I diagnosed and advised about in our living room. She was dehydrated and had a slight fever, so I pushed into her hands a cup of water mixed with electrolytes for her to sip. Since I had the thermometer out, I checked her father as well, and found that he had a high fever of 103. I exchanged my cloth mask for an n95 and dug up some rapid malaria tests from my hallway cabinet (I had them leftover from our travels, never leave home without them if I’m leaving Malawi and going to a country where malaria might be hard to test for.) It turns out that both father and daughter had malaria. The treatment medications in my cabinet were expired, so I instructed the mother to stop by a pharmacy on her way getting those two home.

The next week, my patient was referred for a 3 AM emergency surgery in a hospital one hour away. I communicated with her mother through a series of confusing messages, then finally drove out to the hospital to look through the operative reports, ultrasounds, and lab tests. Only by making the 4-hour trip could I understand the full condition myself, which allowed me to better explain things, answer questions, give counseling, and provide tips for further clarification.

I know this time is a blessing. I haven’t informed most of my patients that I am back to work yet, I haven’t started working full days, and I have left flexibility in my schedule. I have time to contact the patients who have been waiting for me to return and see them first in luxuriously long appointments dealing with all their pent-up concerns. I have time to go to Malawi’s refugee camp and see the situation there with my own eyes, something I’ve been wanting to do for years and never managed. And I have time to think through new protocols and ways to assist families with preventive medicine, plans to collaborate and carry on in areas that others will soon be leaving behind. After Easter, I tell myself, I’ll get back into a regular routine. But will I slip back into old comfortable habits, working in the clinic most days of the week, seeing mostly traditional appointments who book ahead. Or will I be able to keep time open in my day for these unexpected opportunities to serve in unique ways? After 2 years focused primarily on administrative and systems-based work, I’m excited to get back to caring for patients and those relationships that mean so much to me. I’m looking forward to the ways my ministry with patients will form itself. How it will form me in the process.

Dizzy

“Have you ever felt so dizzy that you can’t remember which way is up?” George, Nkhoma’s newly-certified clinical officer, stared at me quizzically and looked back down at his Coke. Because everyone in Malawi knows that the proper response to “how are you?” is “I’m fine, thanks, how are you?” and not whatever it was I just said. I smiled mischievously and got up from my chair. “Here, let’s spin around right now and you will see what I mean. After a few turns, the whole room will look like it’s moving even when we are sitting still” George, the doting father of a 3-year old, knew what I meant then. Eighteen months ago, when I arrived at Nkhoma Mission Hospital, it felt like I was hitting the ground running – and I ended up with ulcers and burnout within the first month as evidence of my enthusiasm. This time couldn’t be more different; we’ve been back 17 days, and I feel like I’m just staring up at a ceiling as everything spins around me. First, we adjusted our troublesome sleep-wake cycles, then I met with key leaders at Nkhoma about what work I could do, looking into opportunities for short and medium-term projects as we prepared to do more work outside the hospital long-term.

That’s when everything started moving at a dizzying pace. Opportunities at Nkhoma seemed scant for me, while Nazarene pastors in the community were desperate for trainings in the next few weeks before harvest and a hospital in Lilongwe was operating as best it could with 4 specialists gone and looking for assistance. One week we looked casually at a few rental houses in Lilongwe, and the next we were preparing to move. This will be the ninth move for us in our nine years of marriage. One might think that it would be easier after all this time, but I think it’s actually harder. Uprooting is excruciating – from the tearful goodbyes not quite alleviated by intangible plans to continue friendships at new distances, to the very tangible pulling up our dog’s chain link fence and our tea garden pavilion. We’re not sure how we or our items will plant down in a new location. Will there be opportunities for deep roots and ministry fruit in this new space created?

Promising porch at our intended future house in Lilongwe We don’t know when exactly we can start trainings, and I don’t even know what hospital I will start working at, or what group will sponsor our transferred Employment Permits. It’s painful and uncertain to step out in faith without knowing where or when the next foot will land. But we trust our pastor friends, that aligning our ministry in supporting them will make the biggest long-term impact we could hope for. We are excited for the chance to see them every week instead of a few times a year, and Greg is definitely eager to exchange his 90-minute commute to the Nazarene College for a 15-minute drive. As for me, having patience and not going to work in a hospital every day has left me unsettled. My final resident teaching session yesterday was so refreshing it was hard to admit it would be my last. But God has provided me with some part-time work I can do from home, flexible work in curriculum development back in America that promises to be uplifting, impactful, and able to supplement our upcoming expenses of renting a home in Lilongwe.

Much remains uncertain, but we trust that these steps will lead to divine appointments and lasting fruitfulness. Please reach out to us if you would like more details on our transitions, and join us in prayer:

- For wisdom as we end old ministries and begin new projects, with safe and healthy transitions

- For coordination of next steps for community trainings in the villages and clinical work in Lilongwe

- For Nkhoma hospital and its staff as it continues to move toward its mission and vision

Thank you for your continued encouragement and support,

- Greg and Christina

Cleaning House

I cleared out my things from the office yesterday. The water filter will help Geerten stay hydrated, the tea set goes to Doreen, the remaining blank gold-framed cardstock certificates will wait until there’s a chance to print a “Thank You” or a “Congratulations” in a new context. I sit next to our recycle box and sift through papers one by one. Frist are the schedules, printed in blue and black with marks from where they were pinned to the office bulletin board every month. Pristine printouts from September 2019 transition to overwhelming scribbles by December 2019, with something re-arranged or squeezed in every day. I think of how my life ebbed on the edge of burnout during that time. I see it in the crossing out, re-allocating, and re-drafting of my job description. I see it in the colorful printed sheet of my mission focus areas and boundaries. I think of the people who helped me stay strong during those times. I can see them, in fact, in printed photos from our ward Christmas party and smiles from our happier moments. I kept them prominent on my wall all year, long after many of the friends and colleagues featured in them had moved on. That color printer which I carried over in my suitcase 18 months ago was a mainstay of ward motivation and organization, a “game changer” as my colleague called it. Safely back home now, I wonder how it will prove its usefulness next.

By May 2020, my schedules start reflecting the effects of COVID – no more visitors, not much teaching, just meetings and Disaster Preparedness contingency planning for the pandemic day after day. I rummage through sheets of PPE guidelines, COVID treatment protocols, and community education pamphlets. It’s bittersweet with reminders of policies which never had a final version because national best practice and local colleague concerns changed so rapidly. I sift through fliers about community interventions that started with so much promise and expired for reasons that still make my heart ache. Some papers I stuff into my plastic organizer for later use – printouts from presentations about “What is Preventive Medicine” and patient diet education sheets. Others are hard to let go of even as I acknowledge it is time: the sheet of plans for hospital employee wellness, a resident’s goals for work-life balance, a list of priority projects to start next as soon as someone showed interest in championing them. It’s cathartic, perhaps, an unloading of burdens I couldn’t carry. But there’s a disappointing emptiness as well, and end of plans and hope that I can bring improvements at this hospital.

And then that’s the end of the papers, the end of the 2-dimensional summaries of my time at Nkhoma. The recycled sheets will be turned into briquettes and bring a warm fire to someone when the nights get colder. But how will my life be repurposed? What will our ministry look like outside the walls of a Mission Hospital? Can we really make a difference in community health and working with pastors? My time at Nkhoma has really ended; I’ve said my goodbyes and we move back to Lilongwe in days. There are no schedules printed for any of 2021. I don’t even know what comes next week, much less next month. I don’t think I’ve ever stepped out in faith like this before, leaving space in my schedule even though I didn’t have a set program to pick up next. I’m not even sure I have a safety net in place in terms of employment permits, clinical work, or full-time ministry. There are so many promising opportunities, but lots of waiting to see what is really possible. I wonder what I will be sifting through and reflecting on a month and a year from now. Things will present themselves soon. But for now, it’s time to stand up, shake off the dust, and start moving.