October Details 2023

Teaching Pastors

Greg has been asked to start an additional training for about 45 pastors in the Mphewa area. He is planning to start next week, and could use prayers for logistics and wisdom as he moves forward teaching two cohorts at the same time. For more information, see the story about this at MalawiMillers.com

Travel Plans

We hope to travel to a forest lodge this weekend as trip #2 of the 3 trips we won in a raffle. Christina had planned to take a trip to Israel in December, and now that is being refunded, we are considering whether we should travel in Malawi over the holidays or down to South Africa to see family. Christina took 3 days off last month and is looking forward to taking more vacation in the future.

In the Community

This month, we partnered with our friend Roberta to source books to equip a school for orphaned children. We also helped retired nurse Mrs. Selemani as she developed a vision casting event/screening activity with the Anglican churches. We are looking forward to how we can work together to pair health and sound theological teaching in this new network.

Banana Bonanza

The banana tree we planted 2 years ago has produced tons of deliciously sweet bananas. We are enjoying banana bread, banana muffins, banana soft serve, and bananas foster as we try to use up all the bananas.

Enjoying the Garden

The scent of flowers drifts through my nose and into my spirit. A mix between jasmine and honeysuckle, these flowers pop out each year from the vine which worked its way from one side of our house, across the other side, along the fence, and over a couple arches created for them. Even during this season, I don’t smell them all the time, more in the mornings and evenings and even then not consistently, they are there one moment and gone with the next inhale. The unexpected sudden burst of the fragrance ensures surprise and fresh appreciation every time I smell them. I wish I could bottle this smell and keep it with me all year. But them maybe I wouldn’t appreciate this season, with all its fleeting joys as much.

October is the heart of dry season, so it is a bit miraculous that we still have green grass and living plants in our little garden. I remember the barrenness of this patch of soil even during green season when we first moved in. It is incredible and satisfying, seeing life and order and beauty were there was emptiness before.

I always look forward to the blooming lavender jacaranda trees, and how they blanket the ground in a carpet of pastel. But I always forget the added beauty of the plumeria and the bougainvillea which overlap the jacaranda blooms, and the bright red flamboyance which blooms not long after, dropping crimson petals on all the other plants so that it looks like everything is bursting forward with red blossoms.

I sit in my cane woven swing and I read bits from the books I brought with me. Forrest Bathing by Qin Li reads like poetry. I take a break to breath in with each line, and I look around me before turning each page. The sky is a subdued pink in the midst of a sunset, the wind rustles through the trees around me, the sunlight dapples down in unexpected patterns, and the birdsong sooths my mind. I am so glad I finished work before 5 today, and that I can take this time of transition.

This year, and partly because of this book, I have learned to enjoy the world around me with all of my senses. Earlier, I picked and ate fresh raspberries and boysenberries on my morning walk with the dogs, and every day that a new strawberry is ready I love the exquisite sweetness produced in our own hanging garden.

I feel the wind on my face. I love the sense of rocking back and forth in my swing, like I am untethered and light on this earth and yet enjoying nature all the more. I am surrounded by flowers we planted and rose bushes we picked out together on dates to our friend’s nursery. Today, pink and orange roses are blooming. The garden changes as the bushes cycle their colors.

I flip through a quick chapter of my second book, Walden Pond by Henry David Thorough. I didn’t think I would enjoy this one as much as I am enjoying it. He writes of a simple life, a life unfettered by drives to consume and gossip and life connected with nature, content in solitude and simplicity, life concerned with ordering the mind and the soul. I don’t agree with some of his philosophy, just like I don’t agree with the entire world view of Li, but I can appreciate these men, separated by half the world and 170 years. They teach me how to rest, how to be present in this moment, in this space.

How much of my life have I rushed from one thing to the next? How much have I forgotten to take transitions, forgotten to appreciate the seasons and the beauty around me? I want to have more afternoons like this, to have more appreciation of where God has placed me, to live in healthy rhythms and to live through all of my senses.

We don’t own this land, but we steward it and order it and care for it and enjoy its beauty. We’ve lived here longer than anywhere else in the last ten years. I wonder how many more seasons, dry or rainy, we will have here. I’m thankful that we can treasure this time and this place so fully in the present moment.

Vaccine Visits

“Why did you wait so long to come back for more vaccines?” It took me a minute to answer the Health Surveillance Assistant, then I remembered. “We needed to wait 6 months between the pentavalent vaccine, and the mother wanted to get all the catch-up shots at one time.” At this point, the community health workers administering the Malawi government vaccines looked at me like I was a bit crazy. “But we only wait 2 months between those vaccines in children” she said. “I know, but this child needs to follow the North American guidelines.” I summarized. In truth, this sixteen-year-old with no past history of vaccination was adopted by a Canadian mother who wanted to follow the Canadian guidelines in case he traveled back for school. Every province in Canada has a different vaccine schedule, mostly giving 5 of these types of vaccine and finishing by 6 years old, but they don’t publish how to catch a child up in his teens. So I’ve been using the CDC schedule, which recommends only three doses of these vaccines if the last dose was given after the child’s first birthday. Today, he was finally catching up. We caught him up on Measils and Rubella, but we had to skip Mumps because only the MR, not the MMR was available in Malawi. I was very thankful that we had gotten this child a rabies vaccine, since the situation can be dangerous around here. I have to admit, even with my research and expertise, I wasn’t sure what to do with polio. Malawi gives 5 doses, finishing by 14weeks. Canada gives 4 doses, finishing at 6 years. And the CDC recommends 3 doses if the child is more than 4 years old and if there has been 6 months since the last polio vaccine. But then there was the fact that we are in the midst of a polio epidemic in Malawi and I want him to have the most protection possible, and there aren’t really polio vaccine recommendations for children in countries where there is actual polio in the water systems. I hadn’t made a note for more polio today, so I wondered whether that was a mistake, or whether he had gotten the vaccines but we had written them down elsewhere.

I finished clinic so early that Greg was surprised to see me home. But it actually took me a couple hours to write up vaccine recommendations, double check the Canadian websites, and find a place where the mother could ask a Canadian public health official about further recommendations. I helped another family with vaccines this morning, and so I also wrote up a list of vaccines the child had received in Florida and here, which they planned to send to their US-based pediatrician to ask if anything else was needed. Between the initial long consultation making plans for these kids, the sourcing and delivery of the vaccines, and the follow-up paperwork, it isn’t unusual for me to spend three hours helping each of these families. I think I’m the only doctor in the country who is willing to take the time to figure out the puzzle of vaccinations for multinational families. Even pediatricians and other family medicine doctors in town refer to me for this. It fits into my scope of a preventive medicine doctor, but I had a lot of help from a handover from my friend who was doing this before me. Even knowing where to source the vaccines and which nurses are comfortable giving a subcutaneous injection didn’t come easy.

So I didn’t see many patients today, but I believe I helped these families who might have struggled to protect their children otherwise. Even though I’m not busy seeing all the patients who come through the clinic door, it is nice to know that I have a role which no other doctors are willing to take the time to solve. Now, if only I could figure out what to do with the polio shots….