Staycation

When I couldn’t travel in March, I was happy to pour myself into COVID-19 disaster preparedness at the hospital instead. In April I tried to make up the vacation time, but besides not finding a great time when others weren’t off or needing to consult me, most of the places I’d normally travel to in Malawi were closed. So when May rolled around and I started looking for time to take off, it was a real wakeup call when one colleague suggested that I just wait until Coronavirus was over and then take vacation. That shocked me because now it seems like this virus will be an issue for us all year. Two months ago I was shocked when a doctor colleague asked about my plans for combating “preparedness fatigue.” Now, I felt like I was limping along, very much in need of time away.

So I checked in with management and colleagues, cleared my schedule, promised to check phone and e-mails once a day, and set off for a 10-day staycation. The first few days weren’t easy – I found myself in the hospital at meetings and responding to texts late into the night. But then I hit my stride. Greg and I constructed a running track around our yard, and I enjoyed running with the dogs every morning, stretching and reading, and often taking a bath or a nap afterward. My average tea consumption went up to about five cups a day, and I also made sure to eat plenty of fruit. We ate breakfast on the front porch and on the back yard swing. We spread out a picnic mat and enjoyed the supermoon one night. We took walks to enjoy the sunshine mid-day and projected movies and calming views from past vacations on a sheet in the yard at night.

It was just the reprieve I needed. I read Victorian romance novels. I chatted with friends but avoided in-person social gatherings. We dipped homemade chocolates. I gardened. Though my attempts at bonsai trees are not going great, my lawn and rose bushes are starting to look better. We discovered potential for a bamboo garden and finally hung some pictures on the wall. We played ping pong and practiced waltzing in our living room a little. I ran with some friends, watched TV shows, and played online games. I even started getting into better prayer habits and methods for memorizing Bible verses. We slept in until 8 or 9. We took a date into town and bought pastries and sipped tea and came home with pretty flowers for my garden. We had a lavender footbath. I think Greg was impressed that I was able to rest so well. I’ve been practicing using my weekends well, after all. As I’m writing this, I’m interrupted by a man at the gate selling fresh honeycomb. Time to take a break for a chocolate matcha latte and some delicious honey straight from the comb. I will need to remember these days when the more difficult times come. But at least now I know how to take time to rest with the simple things at home between the difficulties of work.

Hackathon

I wonder if we were the first team to win a hackathon with such a low tech solution. Ten days ago I didn’t even know what a hackathon was. Even now, I’m not entirely sure. But when a friend told me about a 48-hour MIT-sponsored team collaboration to help tackle issues of COVID-19 in Africa, it sounded like a win-win situation. The wisest thing I did was ask Nkhoma’s young communication intern, David to sign up with me. I might have predicted trouble with apps and audio and visuals, and when they came along, David and helped me through with a smile on his face. We spent 36 hours in front of our computer screens, breaking only for sleeping and eating the food Greg put in front of us. We teamed up with four others specialized in medicine, science, epidemiology, and surprisingly, a high school student with an impressive knowledge of global health who led the way with all of the technical and program details. The time difference meant that we went to sleep when it was early evening for everyone else, but by the time they woke up each morning, we had impressive progress on the items from the night before.

Almost every other group focused on technological solutions to help manage the incoming wave of viral infections on the continent. Compared to that, our non-woven polypropylene bags and community-based initiatives seemed a bit primitive. But I was pretty sure that technology wasn’t the solution in a place like Malawi anyways. Originally I went into the weekend hoping I could learn from someone how to develop a pulse oximeter or a ventilator using locally available resources. But none of those solutions could be mobilized rapidly on the community level. Since we needed something that would promote community buy-in and last throughout the pandemic, we settled on easy-to-access and region-modifiable information designed to help community health workers step up as the first line of COVID-19 triage decision makers in their community. We added stickers to spread information in communities and instructions for making masks and hand-free sanitation stations. Altogether, it was a bag printed with community teaching with information inside. The judges called it low-tech, but really it could be considered no-tech. After I gave my 3-minute presentation on behalf of the team, I wondered if we should have included a flash drive in the bag so there was some amount of digital data in our solution. But we were selected winners in our category nonetheless.

The most exciting part of it is that we can already start printing the information and adding it to the Health Surveillance Assistant education that Nkhoma’s community partners have sponsored this week. Our one-page resource may be just the thing to augment the 50-page instructional handbook that Malawi’s Ministry of health just produced for community workers. It will take longer to actually fund and print the bags, but we’re excited to have something tangible to start with even now.

Ping Pong Practice

These days, Greg and I enjoy daily ping pong rallies, ever since we received a table generously on loan from a friend. I love the predictable rhythm of the ball back and forth, the challenge of its changing direction and speed.  Being a missionary in Malawi during this time is a bit like trying to keep that plastic ball in motion.  We set a policy for a triage system outside the hospital, but there is concern from community members with proximity to houses.  So we move the triage station inside the gate.  We formulate a plan for staff to earn incentives while doing extra triage duty, but there is no money.  We apply for tens of thousands of dollars in grants from existing partners to fund personal protective equipment and additional salaries.  But there is concern about the equity of staff incentives between groups.  We screen thousands of patients and work with the Ministry of Health on some suspected (but ultimately negative) cases, discovering in the process a dozen surprises which send us in new directions.  We formulate standards for protective equipment based on international best practice. We revise the plan again and again after asking all departments and cadres of staff for their input and concerns.  We work together on a plan to source more supplies and sterilize and reuse the supplies we have. Then the Ministry of Health begins to draft a set of recommendations with some components which we never anticipated. We struggle to prepare to accommodate even as the policy is still under draft.  It’s like a constant volley, back and forth, moving and adjusting, doing the best we can.  At this time, we expect the ricochet, we look for the bounce back like a familiar rhythm. We create plans for community education, everyone from community and religious leaders to clinics which depend on us near and far.  Then the government plans a lockdown, limiting travel and meetings. Next an injunction is granted so that the lockdown cannot happen, not now at least.  We poise ourselves to handle whatever comes next.  Then nurses and doctors and clinicians throughout the country withdraw from the workforce as a unified group.  We can’t predict the impact on our private rural hospital, but we take a breath and consider how to keep things from dropping to a dreaded standstill.

Maybe that’s why we like ping pong, it’s a metaphor for life and work here, but that ball is so much easier to control, and easier to set down and the end of a game, than the systems-level issues of trying to prepare for a pandemic in a low income country. Ultimately we need to be able to step back and realize that alone we cannot manage the preparations for this incoming disaster, and we’ve begun to see the need for building resilience and setting boundaries even now.  So we play ping pong, we swing on our new backyard swing, we call friends and family, and enjoy our precious down time. We make contingency plans as a couple, as well as a hospital and a community.  These are hard times for us, same as everyone. But God is good, and we will bounce back.

This month, please join us in prayer: - For healthcare professionals in Malawi and around the world to stay healthy and serve faithfully - For safety in Malawi, that people will work together and not let fear cause violence

Thank you for your prayers and support,  

Greg and Christina