First Two Years - Christina's Weekly Reflections
Updated: Jan 22, 2019
During my final days working at ABC clinic, I’ve been blessed with great interactions with patients I’ve come to know and appreciate. Patients who started out with uncontrolled diabetes, uncontrolled blood pressure, uncontrolled depression, who now have smiles on their faces and hope for the future. It’s been a blessing to be the first doctor to explain things to some of them – patients who for the first time feel like healthcare is a partnership and they can make decisions about how to pursue better health for themselves. It’s so hard to leave these people whom I care for – not only caring for their health concerns, but coming to know them as individuals and caring about their families and life goals. I’m praying that I get a chance to come back soon. It’s different from three years ago when I said goodbye to the patients I saw in San Bernardino. With them, I could send them to any number of my colleagues, and the few that insisted they wanted to stay with me I joked that they could follow me to Africa if they still wanted me to be my patients. But my Lilongwe patients don’t have as many options. There are a few specialty-trained doctors in down and they are either so busy that it is hard to see them or so expensive that most people cannot afford to see them. I know I fill a need here. At my going-away party, one of the clinicians said that he hoped that I returned as a lecturer because I am good at explaining things to people. It’s true, I hope that my next posting allows me to train a future generation of doctors and clinicians so that there won’t be such a huge gap when one primary care provider leaves the city. Oh, that God might give us strength and arrange everything for the next step of our journey.
My days at ABC are slipping away. I had to turn down a new patient on Friday because I was so backed up with patients I already knew who wanted one last visit. I am fortunate to be able to keep in touch with patients via e-mail, but as my hours in clinic go down, the things to do electronically are going up. About a dozen messages a day – people with questions about blood pressure, diabetes, upset stomachs, notes for insurance, advice about preventive measures. I didn’t know that so many people had questions for me in one day. I understand, it is hard to find good primary care in this city, in this country. Many have been abandoned by doctor after doctor as the medical practitioners leave for better situations. And it’s hard. It’s hard to pay so much for medical licensing in Malawi. It’s hard to struggle for that temporary employment permit. It’s hard to go through medical orientation at the central hospitals. And it’s hard to deal with the different culture -with getting pulled over just driving down the street, people asking for something every time you walk through a parking lot. Doctors keep coming, bu
t they keep leaving, too. And I’m leaving soon. Not for long, I hope, but long enough that these people who have come to trust me risk feeling abandoned. No amount of extra prescriptions or assurance that I hope to be back as soon as possible can help with that. As for me, there is plenty to keep me busy with the move and finishing up with commitments here and thinking forward to the future. But it’s hard for me to let go, too. When someone trusts you with their health, with their very life, it is hard to stay at home packing, to send off a quick e-mail, to leave the country for six months and trust that they will still be OK physically and emotionally. Praise God that He is the one who heals and knows all things. I’m just blessed to be a part of His healing in this part of the globe, and I need to trust that His work will go on even when I’m half a world away.
Week 97: What Comes after a Heart Attack
After receiving dozens of calls from the evacuation insurance, staying several hours late at work, and even getting a call at midnight about the patient with a massive heart attack (see week 95) I was a bit concerned that I hadn’t heard anything for two weeks. I always give patients my e-mail so that they can update me, and I did provide a comprehensive transfer document to the receiving team with my contact information as well, so I thought I might have heard something. I knew that we sent him to the ICU across town, near the airport. I even called that ICU when the evacuation team was trying to get in touch with the patient and his family for final permission for evacuation (because there is neither cardiologist nor catheterization lab in Malawi, and the patient needed both) before his planned departure. And then, silence. So imagine my surprise when, 14 days later, he comes marching into my office looking like a new man. No breathlessness, no sweating, not even that dull pain in his feet that he used to get with exertion. He told me that the cardiologist said his heart attack was large and in one of the worst places possible. He stayed in the ICU in South Africa for one week, and now was recovering at home. He stopped smoking and started following my diet advice (his wife was very encouraging, he was still trying to get used to it.) But he truly had a life-threatening condition and now he had a fresh beginning. It was exciting to talk about his future – how he could stay healthy, what he needed to know to reduce his risks, how to control his blood sugars, all the things that I specialize in. And at the end of our consultation, we bowed our heads to give praise to God for his healing. As a mission hospital, we have the phrase, “We treat, God Heals” printed on all our letterheads. But so often, if we do remember to pray, it is when there is a case that we feel is too complicated for us physicians or there is nothing more to do. But recently I’ve realized the value of praying prayers of gratitude for healing, since we admit that the healing comes from God, not us. This patient in particular, I think he knows how close he came. Even his son rushed down from the UK to visit him in the ICU in case this was the end. But hopefully instead it will be a fresh beginning, not just medically and relationally but also spiritually. The words of the Psalmist seem particularly appropriate for this case: “Create in me a clean heart, O God, and renew a steadfast spirit within me.”
Week 96: Finishing Well
Finishing well is hard. I’ve seen missionaries and healthcare providers avoid telling people about their impending departure because they don’t want to think about and aren’t ready to prepare for it. For me, finishing well means transitioning over my responsibilities, creating plans of follow-up for each patient, and not picking up new things. In the past weeks, I’ve had to turn down projects and initiatives. I keep meeting patients who I really clicked with, patients who were happy to find me, patients who I have to warn that I am only in town until the end of the month. We make plans for e-mail communication, doctors who can help in times of emergencies, where to fill prescriptions while I am away, how they might book with me again in six months if I hold a clinic in town on Wednesdays. I’ve trained my colleagues and shared protocols and handouts so that they can reproduce what I do. But it’s still hard. It’s hard to start letting go of things even when there is nobody yet to pick them up. It’s hard to avoid taking responsibility or leadership if things are inefficient, but that is what phasing myself out is all about. And I think that’s my role for now. Some of my colleagues wished that I was working more in these final weeks – I know many patients wish they could have another appointment with me and then another. But in the long run, I think it’s better that people start practicing filling in responsibilities while I’m still around to advise them how to do things. I have to avoid thinking that everything is on my shoulders, to realize that as soon as I step back, others will fill in, or else the organization will re-align itself to fit its current capacity. It’s hard. It would be easier to burn myself out until the end and then leave without looking back. But I think that a lot of Malawians, a lot of Africans, have felt abandoned by foreigners before. I am leaving, but I want to leave this place better than when I came. God help me.
“Trust Him at all times, you people. Pour out your heart before Him. God is a refuge for us.” – Psalm 62:8
Week 95: Team Work
“Peace I leave with you my peace I give to you; not as the world gives do I give to you. Let not your heart be troubled, neither let it be afraid.” – John 14:27
I arrived to the clinic towards the end of the lunch hour and found that there were already two patients waiting for me. The first one to arrive was a man in his late 50’s with some tightness in his chest that felt like acid reflux, but wasn’t improving after 3 days with medication. His physical exam was normal, except for a fast heart rate, but because of his diabetes and smoking, I was a bit concerned about his heart. I wished that I had been able to see him a year ago, and prevent these problems in advance. I sent him off for some lab tests and a heart tracing, and began to see the second patient. Within minutes Dr. Nthakomwa came running up to my office, waving the ECG tracing, which clearly looked like a heart attack. Although we are a small, community hospital without many resources, it is amazing at how seamlessly our team has started being able to manage heart attacks. And that’s a good thing in a country with no cardiologist or cardiac cath lab. Dr. Nthakomwa started on the classic heart attack treatment of oxygen, morphine, and aspirin and repeated heart tracings regularly. Dr. Mutafya coordinated with an incredible pharmacist kept a stock of the only clot-dissolving medication available within hours. This was provided along an injectable blood thinner, valuable heart-saving medicines given quickly although the patient couldn’t pay for them right away, which is no small feat in Malawi. I worked with the patient’s international medical insurance and evacuation insurance and coordinated his transfer to one of less than a dozen ICU beds in town. When Dr. Nthakhomwa completed an echocardiogram image of the patient’s heart showing that his massive heart attack was not improving with medical treatment, we started preparing for his evacuation. I gulped down a quick dinner during the spaces between which my phone would drop and then receive new calls from the insurance company in South Africa. I rushed home to type up a transfer document for the patient’s evacuation as the patient was in route to the other hospital’s ICU. And just when I thought the patient was set for evacuation, I found myself trying to connect the patient’s guardian across town with the evacuation specialist in Madrid to finalize the details of the patient’s dispo. Because of the limited resources, Malawi is not the best country in which to have a heart attack. But that day, our team did so well. I will miss my colleagues and the incredible things we are able to do together, me the Preventive Medicine specialist working on systems-based issues, Nthakhomwa the future cardiologist following up on the most detailed analyses of heart function, and Mutafya the brilliantly efficient clinician who will some day change the face of medicine in this country.
“But none of these things move me, nor do I count my life dear to myself. So that I may finish my race with joy, and the ministry I received from Christ Jesus, to testify to the gospel of the grace of God.” – Acts 20:24
They rolled his wheelchair into my office. His medical chart read simply: Dr. Miller, second opinion. He said that he had met me before two months ago, but I truly didn’t recognize this emaciated man, bent over in pain and barely able to whisper breath. But then he started pulling out his various medical records and whispering his story to me. I had met him before – when he was 10 kilograms (22 pounds) heavier and the pain was only moderate. He had come to our clinic with abdominal pain and vomiting. He had a stomach infection, but not bad enough to explain his symptoms. He had diabetes, but not bad enough to explain his symptoms. In the end, we sent him home because we didn’t have a reason to keep him in the hospital. Since then, he had been to half a dozen other private and public facilities, for multiple admissions at each. His pain became uncontrollable, his weight melted off. Surgeons, gastroenterologists, infectious disease specialists, no doctors in town could figure out what was happening. He was one of the fortunate patients with resources, so he got ultrasounds and an endoscopy and even a CT scan. But nothing explained his symptoms. Even in America, we have cases like this, where the best specialists and testing does not reveal a clear diagnosis and where no treatment is available. They train us how to counsel patients, how to help them deal with the stress of not having a clear solution. I explained to him that this was a very serious condition, and we needed to treat it seriously, even if we can’t find exactly why it was happening. We might not find the solution, but we would keep doing the best we could. I explained to the family how the process tearing apart his body was also taking a toll on his heart, his emotions, and we had to take care of that. This for this patient, at least I was able to control his pain, that’s one thing I’m good at from my training. I explained to the family the importance of employing comfort measures so that he could save his strength and refresh his spirit. I invited in the chaplain to help with any concerns and I prayed repeatedly with the patient and his family. Of course we prayed for miraculous healing, for wisdom for the medical team, for God to be glorified in this situation. And that was the most we could do for this patient. I took some vacation days this weekend and during that time the medical team decided to transfer the patient back to the government referral hospital for review by specialists there. This patient reminded me of the woman mentioned in Mark 5, “had suffered a great deal under the care of many doctors and had spent all she had, yet instead of getting better she grew worse.” The patient continues to weigh heavily on my heart. As the motto of many mission hospitals says, We treat, Jesus Heals. Please join me in prayer this month for healing for patients who are beyond our skill and knowledge levels to help.
“I think the best results are obtained by people who work quietly away at limited objectives… I think the art of life consists in tackling each immediate evil as well as we can.” – CS Lewis, The Weight of Glory
“It’s than anticipation factor that drives the addictive behavior and suppresses the altruism center... Throwing money into the mix diminished altruistic motivation and introduced unexpected behavior.” – Ori and Rom Brofman, SWAY, The Irrestible Pull of Irrational Behavior
Sitting at dinner with a group of volunteers newly arrived at ABC, we were discussing how one missionary child had aspirations to be a professional athlete. As the group discussed the improbability of any adolescent going on to play on a major sports team, I was reminded of a time that I counted the difference between professional athletes in America (5000 in the NBA, NFL, NHL, and MLB) compared to the number of missionary doctors currently serving overseas (1200 Christian English-speaking doctors currently serving longer than 2 years overseas). By my count, the child was four times more likely to be a professional athlete than a missionary doctor. And I find that sobering. Of the hundreds of pre-medical students in my matriculating undergraduate class, only about 8 went on to become doctors. And of all the generations of doctors produced from my mission-minded Christian Alma Mater, I know of only to who have served in overseas missions long-term. One of the short-termers, a businessman who helped mentor college students, asked why there was so much attrition among young people who feel called to long-term missions and healthcare professionals who actually make it to the field long-term. At a time when more medical people than ever go on short term trips – hundreds from my employer World Medical Missions alone, missions hospitals are having trouble keeping staffed with specialist, or really any providers, as heroic missionaries head towards retirement. During our discussion, I came up with some thoughts from my own experience – I’ve seen people indefinitely delay a missionary call because they married people who were not similarly called, because they decided to wait for kids or financial stability, or because of health. But really, it’s hard to be a doctor making so many times less than you could make while living in the comfort of America. And it is hard to submit to the years of paperwork and application processes and orientations that most missionary agencies require before being sent by them. Even from my cohort of doctors accepted into this two-year program in 2016, many have found their callings, at least for now, back in America. Greg and I hope to return to Malawi soon, we hope to stay long, I believe that I am one of those who will actually make it and make a difference over here, the kinds of differences that take years or decades to etch into a community. But who can say, who can judge, who can know what the future will hold? “Now listen, you who say, ‘Today or tomorrow we will go to this or that city, spend a year there, carry on business and make money.’ Why, you do not even know what will happen tomorrow. What is your life? You are a mist that appears for a little while and then vanishes. Instead, you ought to say, ‘If it is the Lord’s will, we will live and do this or that.’” James 4:13-15
Week 92: Discipline
There are some things that I’m excited about – things like packing up items one by one, organizing some to wait for us when we come back next year, giving away others, and taking just a few back with us. Planning for and thinking about travel is fun, and helping to plan programs at Nkhoma is exhilarating. But other things are daunting. Immigration – going through the employment permit process again, car registration and then storage, getting the dogs ready to stay with Ishmael, and getting his place ready for them; Packing up those little fun things like paintings and souvenirs and photo albums that make me feel at home here and living for some time without them. Figuring out just enough food to buy so that we can finish it before we go. Trying to stay healthy with sleep and exercise and work-life balance until then. Those things are hard just to think about, much less dive in. I was so thankful to find that tomorrow is a public holiday. I had forgotten about it so I didn’t plan anything, and I’ll get most of the day to take care of some of these things. But even so, it takes so much discipline. Makes me want to bury myself in work or books or anything else, anything other than long-term planning. I’m excited to be back in America, but I know I’ll want to be back in Africa as soon as possible. Thus, discipline for now.
“No discipline seems pleasant at the time, but painful. Later on, however, it produces a harvest of righteousness and peace for those who have been trained by it.”- Hebrews 11:21
Week 91: Economics, Part 2
“It is not what a man does that determines whether his work is sacred or secular, it is why he does it. Let man sanctify God in his heart and hereafter do no common act.” – AW Tozer, The Pursuit of God
“Is anyone among you sick? Let him call for the elders of the church, and let them pray over him, anointing him with oil in the name of the Lord. And the prayer of faith will save the sick, and the Lord will raise him up. And if he has committed sins, he will be forgiven.” – James 5:14
As I reflected 6 weeks ago, Thokozani told me about a child in her village who was abused by his father as a way to promote business through witchcraft, and his mother felt powerless to help him. At that time, I brainstormed with my pastor friend about how we could help the situation. In the end, Thokozani’s women’s group provided the woman with a $37 loan to start a donut baking business. The loan was repaid in advance by some American well-wishers, but it was important that the woman saw it coming from within her community. She has since been able to sell her products, renew her starting materials, and invest about $12 of profits back into the group, thereby joining the women’s microfinance group that meets twice weekly at Goshen church. The woman related that her husband did not take any of the money or supplies from her business, because he was not involved with providing the funds in the first place. He did ask her to inquire about when the loan needed to be repaid, and my pastor friends told her this time would be a gift as long as she continued to manage her business well. Thokozani tells me that the child, previously standing out as poorly dressed and neglected, now looks “smart” and even brags about getting a juice drink at home to boost his nutrition. It was such a small gift, something we would have spent on a nice dinner or one night out in America, transformed this child’s life and his mother’s sense of agency. So many of us try to make a difference in this world, and even those of us willing to part with our money for a good cause have trouble knowing where and how it can make a difference. I can’t relate enough how much I respect and appreciate my Malawian colleagues, working in the village, living an hour away from the comforts of flush toilets, electricity, and running water. They build churches which shine lights in the community, schools who accept disabled children with open arms, and women’s groups who give power to the ones who can change families and communities for the better. Truly, these are the ones who are most building the Kingdom of Heaven in this world, and we are so blessed to partner with them.
“Our gifts and talents should also be turned over to Him. They should be recognized for what they are. God’s loan to us, and should never be considered in any sense our own. We have no more right to claim credit for specific abilities than for blue eyes.” – AW Tozer, The Pursuit of God
“How many people are basing their opinion of God on how they see you act in time of stress of trouble?” – Beth Moore, Living Beyond Yourself
The nurse ran up to me and told me that my 9:30 appointment was in the treatment room because she was having trouble breathing. Nothing gets my attention quite like limited oxygenation, so I excused myself from my 9:00 appointment and sprinted down to the part of our clinic which offers a higher level of care. It didn’t take us long to get her breathing better – she developed pulmonary edema because she stopped her diuretic, so that was easy to treat. But she stopped the medication because she was getting dehydrated from extremely high sugar – sugar so high it was undetectable by our machines, so that took a bit longer to stabilize. The dehydration was basic enough – take the fluid from her lungs with injectable diuretics and give it back to her orally to hydrate the rest of her body. The sugar, quadruple her levels from a month ago and accompanied by a quadrupling of her inflammatory white blood cells, both of which we all soon agreed were from her recent use of steroid medications, took days to get under control. Unlike usual patients whose diet strongly influenced sugars or whose systems responded to a set amount of insulin predictably, this lady needed 6 injections of insulin in her first 16 hours of admission just to come into less dangerous ranges. Our nurses were fantastic, though, checking the sugars closely throughout the day and night, and offering advice on meal planning for the patient. It doesn’t usually take me 5 days to stabilize a patient, but this one needed every day of it, plus an inpatient consult with the hematologist about what to do next regarding anemia.
The most impactful part of the case, however, will stick with me. I walked into her room on the second day and apologized that the medication given to her last month had caused all these side effects. Sitting up in bed, she turned to me and smiled. “You’re not God.” She told me. “You can’t predict or control who will get side effects.” It was one of the most gracious things a patient has ever said to me. A mantra that I have repeated to myself since, and one that I think every doctor aught to remind themselves often. “You’re not God.”
“Not that we are sufficient of ourselves to think of anything as being from ourselves, but our sufficiency is from God.” – 2 Corinthians 3:5
Week 88: A Young Heart
“Trust in Him at all times, you people, pour out your heart before Him. God is a refuge for us.” – Psalm 62:8
“Hope deferred makes the heart sick, but when the desire comes, it is a tree of life.” – Proverbs 13:12
He was 36 years old and just returned from South Africa where his wife gave birth to their second child. And on the day before their planned departure to Malawi he had a heart attack. I was so shocked when he came to follow up with me and told me the news. His blood pressure wasn’t that bad, he didn’t smoke, had no significant history, his diet was not terrible, his weight only slightly high, and his cholesterol wasn’t the worst I’d seen. He smiled graciously with my questions and surprises and said that the doctors in South Africa were just as surprised when they saw how much blockage he had in the arteries leading to his heart. In a way, I felt a bit responsible, I had seen him earlier in the year and had performed a full preventive visit. Looking at his numbers, I could even recount the exact advice I would have given him. “You have metabolic syndrome, which means that your body is not processing the foods that you are eating well. Right now, your risk of a heart attack or stroke in the next 10 years is only 1.5%, but that will increase in the future if you continue along this route. Here is some information about diet and exercise which can help reverse the metabolic issues going on in your body.” I had given that advice to countless individuals, and I’d never seen anything bad happen to people who followed my advice. I mean, he was about the same age as Greg and not that different in terms of health parameters! So as a Preventive Medicine doctor, I felt like I had let him down by not preventing this adverse event. But really, as a doctor specialized in Population Medicine, pretty much all that I do deals with risk and statistics, and even if an adverse event has a low percentage chance of occurring, by the time I’ve taken care of thousands of patients year after year, some of them are going to have adverse events. At least with this gentleman, he was in a country with cardiologists and the potential for cardiac intervention, and he was able to have his blood vessels opened up with no lasting problems. And now that he is back in Malawi, both his wife and I are extremely motivated to fully reverse all those metabolic risk factors and prevent any future events. On top of that, now that I am practicing an optimal lifestyle in terms of diet and exercise, I am even better at advising and encouraging patients to do the same without compromise. Oh, but how I pray that the cardiac events in my patients (and my loved ones!) will be fewer and farther between than the statistics would suggest.
Week 87: A Good Pairing
“Bear one another’s burdens, and so fulfill the law of Christ.” – Galatians 6:2
I met Greg exactly 14 years ago as we ran together on the Point Loma track. We now remember the date because it’s Queen Liliuokalani’s birthday, but at the time, I remembered because I wrote in my diary that he was one of the highest quality guys I’d met. Of course, I went on to write that he was really not my type because he wasn’t too competitive or concerned with grades, but even so, it took me less than two weeks to be completely head-over-heels for him. Little did I know that it was those “not my type” parts about Greg that would get me through difficult seasons of medical school and residency as well as heartbreaking family tragedy. Things that would be insurmountable for me are easy for him, like preaching and teaching and keeping calm in the face of stressful situations. Not to mention driving on Malawi’s crazy roads. I honestly didn’t know how to use free time to relax until several years into my relationship with Greg, and I’m certain that is going to prolong my life now. I used to agonize over whether I could ever find someone who would partner with me through a vocation on the mission field. Sometimes it’s still hard for me to believe that this guy I met on the track at the beginning of college is helping me to become the person I was meant to be, a husband who gives me roots at home so I can spread my wings. It’s been an adventure together, one which I look forward to continuing for a long time. But how unimaginably wonderful to be partnered with someone who helps me grow and give and attain and be more than I ever could alone.
Week 86: A Healthy Lifestyle
“For though we walk in the flesh, we do not war according to the flesh.” – 2 Cor 10:3
“The doctor of the future will give no medicine but will interest his patients in the care of the human frame, in diet and in the cause and prevention of disease.” – Thomas Edison
It seems like all Greg and I do these days is eat plants, exercise, and sleep. At the last minute, two weeks ago, we signed up for the Complete Health Improvement Program (CHIP) that our friends are hosting at their house. We’ve spent 3 ½ hours four nights each week traveling across town to eat healthy food and watch videos about health. The other dozen participants in the program compete with each other for who walks the most, so naturally, Greg and I have been wearing pedometers and walking over 10,000 steps a day. We’re sleeping better and spending a lot of time together, and our dogs love all the walks. Running is easier, too, which is something I didn’t expect with cutting out meat and processed carbs (not to mention dairy and most fats from my diet. We’re eating a lot of fruits, vegetables, whole grains, and legumes. I don’t think this is something either of us expected to dive into, but as a doctor I wanted to see what this optimal lifestyle was like before I could unhypocritically recommend it to my patients. Gone are our weekly trips to buy one get one free burger night, but we are learning lots of delicious recipes. I don’t think either of us would have imagined that we’d be embarking on a big change like this together. But it’s been a fun process and journey. I’m so thankful to have a husband who is supportive in all ventures, even the ones that he would never choose for himself.
Week 85: Economics
My friend showed me a picture of a child in her village with a burnt arm, asking if I could help the mother treat the burn. Based on the picture I could not offer any advice at all, because all I saw was a forearm coated in dried mud. But the story about the picture broke my heart. The child’s father practiced witchcraft, and was convinced that his business would profit if he abused his first-born child. His other children were well-dressed and well-fed, but this child was neglected and intentionally burned. The mother had taken the child to a local clinic but now could not return because her husband would not permit her the money for the trip. “I know what I am doing,” he said. He threatened the mother with death if she took the child away, so she seemingly had nowhere to turn. In America, both Thokozani and myself would have been mandatory reporters of this child abuse to the proper authorities, but here in Malawi, apparently only the mother can report cases to the police. There are a few social workers in town, but the general consensus among law enforcement in Malawi is that child abuse does not exist. And whichcraft does not exist. But how the devil must glory in the abuse of a child for the parent’s economic gain. She and I discussed possible interventions. Village pastors and chiefs could be able to talk to the mother or father, and we might even be able to think of a business where the mother could earn some money of her own so that she could afford to take the child to the hospital for now and gain some independence and agency in the future. But oh what unimaginable darkness exists in these villages, cases which I’m sure makes the devil gloat. And the excuse is financial profit in this world at the excuse of the soul and the next generation. Truly, money is the root of all kinds of evil.
Week 84: Death
“If there is an awareness at the time of death, there is pain. Simply put, death hurts.” – Beth Moore, Living Beyond Yourself
“So when this corruptible has put on incorruption, and this mortal has put on immortality, then shall be brought to pass the saying that is written: ‘Death is swallowed up in Victory - O death, where is your sting? O Hades, where is your victory?’” – 1Corinthians 15:54-55
Our clinical team went through a period of several critical cases with poor outcomes, one after another. I personally struggled during that time, carrying a lot of the stress home with me and into my personal life. But I noticed that my colleague, a Malawian doctor who recently completed training, was taking things even more personally than me. We usually sat down and talked about each case, what we could have done differently and how we could improve our care. We came up with improved team communication, protocols, and more efficient transfers to higher levels of care. But one day as we talked, he started sharing his disappointment at having “lost” another patient. This patient was in his 90’s, over 30 years beyond the life expectancy in Malawi, and came in with a terminal illness. And this young doctor was feeling personally responsible at not having been able to “save” him. I launched into sharing some of my struggles and perspectives with this doctor, things that wiser physicians have taught me, that some patients die on your shift no matter whether you did everything right or made mistakes, and others who you think have no chance live. If you take vacation, some patients will die, and if you work all night and spend all your energy, some patients will still die. I shared with him the key phrases that help me get through, that our struggle is not against death, because everyone dies eventually and Christ already won the battle against death anyway. We’re not the ones who hold the power over life and death, and if we think that everything is on our shoulders, we will burn out. But our role as healers is to prevent death where we are able, and to ease the patient and the family through the difficult and inevitable times through the best care we are able. I’m sure I was preaching as much to myself as I was to him, but I don’t think he had heard a lot of those concepts before. He likely had a lot more experience with death personally and professionally than I did, but at least I was able to affirm him and share some of the supports that have helped me get through. He later texted me, saying that was the most remarkable thing he learned that day. It’s been a painful time. But we’re growing as individuals, as physicians, and as a team that can extend a hand of healing to our patients and our community.
Week 83: Weekend Away
A friend was having a rough month with sickness throughout the family, stressors in the home, and a variety of discouragements from outside. A group of us gathered together to give her a reprieve, some time away with her husband. My other friends did the hard part: coordinating care of her toddler for a full day and into the evening. Greg and I partnered together for the easy part – driving a few miles across town to make a deposit at a nice lodge for their get-away. When we explained our plans to the proprietress, she first said, “I want friends like you!” and later, “Who is going to do something like this for you?” We mentioned how we were already blessed so much with our families and friends giving us retreats with them when we are back home, but we had no idea that we would receive so much in just the next two days. First of all, we received a complimentary tea overlooking the lake at the lodge at the time we went to book that day. The next morning, even before our friends had gone to our lodge, some short-term volunteers offered to pay for us to take them on a safari that day. And these same individuals had brought break calipers so that Greg could finally drive without worrying about the breaks locking or increased tire temperature. Finally, this all occurred on Greg’s birthday weekend, and we previously didn’t have a clue how to celebrate. So we got a retreat of our own, a nice lodge in Liwonde park with stars our window and monkeys on our doorstep. The safari drive was a great experience, our first dry season safari in Liwonde. And it was all provided to us for free at the last minute. So we helped our friends have an evening away just across town, and the same weekend we ourselves received a great expense-paid adventure for celebrating Greg’s birthday.
“Give, and it will be given to you. A good measure, pressed down, shaken together and running over, will be poured into your lap.” – Luke 6:38
Week 82: Ups and Downs
“Let not your heart be troubled; you believe in God, believe also in me.” Jesus, John 14:1
“We are all broken, wounded, and deficient, and we have no hope of helping others until we first realize our own state.” – Greg Seager, When Healthcare Hurts
6:20 I was awake. I didn’t want to be awake. I had not been sleeping well, partly my regular inability to go to bed without doing one last thing, partly my lack of usual restorative naps, partly the long hours at work and desire to use the evenings to rest.
6:25 I took doxycycline for malaria, then Airbourne, then ginger tea. I felt a tickle in my throat and suspected I was getting sick like the missionary family next door who I have been helping care for.
6:45 I didn’t get as far with my Bible study because Greg was up early, trying to finish his ice cream recipe before the power went out. I think that is what really did me in, emotionally. The pieces of the Kitchen Aid machine didn’t fit together due to frozen ice and the wrong attachment. I squealed at Greg, seeing this device that I had dragged halfway across the world seemingly being destroyed before my eyes. And the ice cream itself was not turning out well, we couldn’t find utensils to get it out, it was melting and crystalizing at the same time. My mood turned sour from there.
7:00 I admitted to myself I really didn’t want to go to work today. There was a very sick patient who I admitted last night, should have admitted two days before but the family insisted on taking her home, she had some incurable diseases and now an infection that wasn’t getting better. The family expressed understanding about the difficult condition last night but that didn’t make things any easier. We had just lost a really sick patient on Friday and this was only Wednesday. I had texted my accountability group that I just wanted one week without a death of a patient, but this week wasn’t looking like a good candidate. They said they were praying for me.
7:10 Greg hugged me. What I really wanted was a punching bag. I think I tried hitting and screaming into a pillow. Even then, I wasn’t proud of the way things escalate when I am upset.
7:15 I struggle, looking through spare suitcases. I planned to bring one to Jolyn, whose friend borrowed hers and was robbed at the market. Her son needed one for school.
7:20 I head out the door, suitcase in hand, and pick up Katheryn. I can’t pretend that I’m doing well today. I tell her about the patient on the ward.
7:25 My friend texts me, telling me that she is praying for me.
7:35 We’re at the hospital, singing hymns and praises together as a team. I’m not really feeling like singing, but I think it is helping my spirit.
7:50 They ask me to pray for patients on the ward. I pray generically, not knowing if my patient is still alive, but also pray for strength for the day and God’s spirit working through us. I leave devotions feeling better.
8:05 Dr. Mutafya stops in at my office and tells me that the patient died. We discuss some issues with the case, including lack of communication with the consulting provider and a last-minute transfer attempt that may have cost some quality of care. I wasn’t happy, but there wasn’t much I could do now.
8:20 After debriefing with Mutafya, I debrief with my interns. We have a plan for the day and I am ready for my first patient.
11:30 Unlike the day before, when I saw ten patients before noon, today I had just 3 appointments and I felt able to help each one. I had time to help one woman tackle the most pressing sources of stress in her life and make steps for improvement, and another, a relative of our administrator, I was able to counsel about diet and diabetes, and I felt really honored for the referral. I type off a note to my accountability group, I’m feeling better already.
12:45 On my way up to lunch, my charge nurse called out to me that she was hungry, so I invited her up to my house. She drank instant soup as I made her a marvelous grilled cheese and tomato sandwich. I even completed it to perfection in spite of losing the stove’s electricity halfway through. I burned my right wrist, hoped it didn’t leave a scar. I snacked on a sweet potato as she polished off her lunch and headed back. She had been dealing with a number of stressors, including the recent difficult patient cases, so it was good to have the time together.
2:00 No time for a nap again today, but my friend came over and we prepared for a surprise birthday party for another friend: Greg brought flowers and treats and made the ice cream and even stirred the frosting recipe because the Kitchen Aid was down without power. Ishamel made carrot cake muffins. I prepared a fine tea and set the table. My friends brought more flowers, balloons, candles, and cards. It was a great time, uplifting, encouraging, connecting. Praise God, after that, I had strength to get through the rest of the week, and even be a source of encouragement when others in my group needed help a few days later.
“These things I have spoken to you, that in me you may have peace. In the world, you will have tribulation, but be of good cheer, I have overcome the world.” John 16:33
“Remember, we Christians think man lives forever. Therefore, what really matters is the dark little marks on the central, inside part of the soul which are going to turn it, in the long run, into a heavenly or hellish creature.” Mere Christianity, CS Lewis
Inspired by last week’s sermon about a pastor’s daily prayer, this week I started praying that God would bring across my path someone each day who needed His love, give me eyes to see them, and give me open arms to bring them into fellowship with believers. I know how prayers like that can change lives, so I didn’t know what to expect. What came across my path was patient after patient with anxiety and depression. As difficult as those cases are to treat, with time and patience even a primary care provider like myself with limited therapeutic options can make headway. But most weeks I would have glossed over some of the underlying mental health concerns instead of really trying to get to their roots, so I was blessed to have time for that, and it helped me realize that I want to continue serving in Lilongwe, at least some days during the week, so that I can keep helping with these sorts of needs. Outside of the clinic, God found me, too, with some of my closest friends sick or hurting, and there was time to care for them, sometimes with medical advice, other times with tea and baked goods. And then the work week ended with a case of a very sick patient who we might not have been able to help under the best circumstances, but Friday’s clinic was far from the best circumstance. That was hard for me. But God picked me up and got me through, and those people who I was available for throughout the week were there to help me at the end. I know the Christian life is a marathon. I’ve been inspired by one of my colleagues and his determination to give his best for God each day. I asked him how he had the strength to continue on during these hard days, and he directed me to Colossians 3:23 – “Whatever you do, work at it with all your heart, as working for the Lord, not for men.”
Week 80: Health Walk
“For in Him we live and move and have our being.” Acts 17:28
It was so cold at 5:30 am. Since it’s the middle of winter, the sun was barely up. I trudged to the clinic, devouring my apple along the way. It was our eighth monthly health walk, and I still never knew if I would turn the corner and see the parking lot of the clinic filled with people and cars, or entirely empty. Nebert greeted me. He had worked hard promoting the walk around town and among the clinic staff. He even produced fliers and posters about the event. We discovered just a few days before that there was a fun run to aid Albinism and a clinic outreach for ABC the same day, but by then it was too late to reschedule, so with the cold and the conflicting schedule, we didn’t know what to expect. My whole support team was there – Katheryn my intern who wants to be a medical missionary some day, Lucy the dietitian getting an MPH in nutrition who just started shadowing me yesterday, and Madalo our charge nurse who is my partner in these events, even though this was the first of three obligations she had that day. The patients came a few at a time, more than I expected – and our team checked their blood pressure, blood sugar, and weight. We started the walk within 15 minutes, a pretty impressive feat in Africa at this early hour.
I jogged with the leading half of the group, my interns were in the middle with the fast walkers, and Madalo brought up the tail. As we walk down the bypass road together, I love that we are practicing what we preach, not just doctors and nurses together with patients, but national Malawians with foreigners together side by side, stride by stride. After the walk we rechecked some measurements and did a stretch routine together. Nebert sat down with two women with high sugar and counseled them in Chichewa about healthy eating. Sharing a couple hours with members of the community, giving services and advice for free, pairing screening with physical activity, it was definitely worth the early wakeup call. I love this kind of preventive medicine, of lifestyle medicine. Now, if only I can figure out how to advertise them just enough so that the right number of people come, so that I’m not lonely or overwhelmed.
Week 79: Blood Clot
“Reality never repeats, the exact same thing is never taken away and given back.. for that is what we should like. The happy past restored.” – CS Lewis, A Grief Observed
“For to be carnally minded is death, but to be spiritually minded is life and peace.” – Romans 8:6
She looked up at me with wide, terrified eyes. “I’m not going to make it” she said in a panic. I didn’t want to lie to her, she and I both knew that her condition was serious. She had a blood clot blocking both branches of the blood vessel going from her heart to her lungs and back. She needed a cardiac surgeon to remove it, and this country didn’t have anything close to a heart surgeon. She was recently married and the evacuation portion of her medical insurance had not begun to cover her yet. We coordinated with the pharmacist across town who heroically obtained a strong blood thinner from a town 2 hours away as we tried to stabilize her for a morning flight on a commercial airline. But the morning never came for her. In reality, she probably wasn’t going to make it, but we were doing the best we could with the resources we had, and praying for a miracle. I rubbed her shoulder and told her that she had been fighting hard, that she could relax now and it was time for us to do what we could for her. Her head rested back and to my terror, she became unresponsive. That was the last I saw her conscious, but my colleagues said that she woke up that night when they were in route to a private ICU across town, close to the airport. But when they arrived, there was no ICU bed for her and no ventilator, so no hope of making it to morning. They were in route to the other private ICU in town when they received call from a provider at the government hospital saying that there might be a bed available that night. So our team sped her over, hoping for the best. It was only the next morning that we heard she had died in the waiting room of the government hospital, without even being monitored or seen. Our clinic was rightly horrified about the situation. We’ve been trying to support each other and also figure out how we can improve care even considering low available resources in the future. We’ve all been processing different ways. For me, I wonder if things would have been different if I had know that she was at such a high risk for a blood clot, could I have counseled her earlier and prevented this?
Then from another perspective, people die in Malawi all the time, and this woman had so many risk factors for this serious event. Why has our clinic been beating ourselves up, even having providers take days off of work due to the stress and grieving, over this one? One of my collegues noted that it might have been because the patient was able to pay for the most expensive medications we could find and the CT scan, and an ICU bed, had we been able to find one. Perhaps when the family is willing and able to do everything, then the strain of working in a resource-poor setting and having an undesirable outcome hits us hardest. I have to remember the words from our conference a few months back, that our battle is not against death. God won that battle. People will die whether I do everything right or not. And people will live whether I’m there or not. So for now, we have to do our best for each patient, trust in God to bring about healing in His way, and then make sure that we are learning from or processing grief from each situation in a way that furthers His kingdom.
Week 78: Sabbath
“If you keep your feet from breaking the Sabbath and from doing as you please on my holy day, if you call the sabbath a delight and the Lord’s holy day honorable and if you honor it by not going your own way and not doing as you please or speaking idle words, then you will find your then you will find your joy in the LORD, and I will cause you to ride in triumph on the heights of the land and to feast on the inheritance of your father Jacob." Isaiah 58:13-14
For the past 2 weeks, I was not able to have a single full day of rest. So last weekend I caught up. I felt like Israel in 2 Chronicles when it was written “the land enjoyed its Sabbath rests.” And the 3-day Malawian Independence Day weekend was perfect for it. It rained, even in the dry season of July, and it was cold, so it was perfect for staying in with our electric heater covered in blankets and jackets. I made a priority of spending time in the Word. I cleaned the kitchen a bit, drank lots of tea, and slept, even napping most of the days. I stayed home for 48 hours straight. By Saturday evening, I spent 90 minutes at a friend’s going away party, and Sunday after church met up with another friend for tea for another 90 minutes. Besides documenting 56 back-dated prescriptions to help a friend with her insurance paperwork, I was wonderfully unproductive all weekend. There were about 96 wonderful hours before I had to set foot at work again, and I felt so renewed. It made me realize that I really should try to make sure that I get my sabbaths back, a full 24-hour period every week if possible. And Greg and I even talked about a sabbath year sometime. I guess you could say that 2016 counted as a bit of a sabbath year. So maybe we should count from there and look forward to 2023. But weekly sabbaths are becoming more and more precious to me. I think I might not even turn on a computer or phone one day a week to make sure there is time for it.
Week 77: Boundaries
“We may plan to stay forever and commit with noble intentions to do one thing for the rest of our lives. But when the Spirit of God moves within us, we must move with him or be miserable.” – Beth Moore, to Live is Christ
I’m such a people-pleaser. I think most doctors are. Especially female doctors, Family Medicine Doctors, Christian doctors, and missionary doctors. I love it when my patients appreciate that I go the extra mile, it makes me willing to pour myself out for them. Like Mr. K who always smiles at me and takes my advice, or Mr. P who lost 10 kg in 6 months, stopped smoking and drinking, and lowered his blood pressure without meds. He even referred his grandmother to me who lives 6 hours away. I don’t mind patients sending me e-mails with their concerns, even when I’m exhausted in the evening and the last thing I want to do is write one more doctor’s letter or e-mail about a prescription. But I do have boundaries, that’s how I survive. I told them not to give MK my phone number, and asked her to come in for a consultation during my regular hours. A 2-year old’s parents saw me one day and complained that I had refused to give them my number, because they had come the evening before and had hoped to see me instead of a clinician. I stated my usual reasons: we have a strong team who is able to help them 24-hours a day and is able to call me for consultation in emergencies; my phone is often on silent or not with me, so I don’t want people to rely on that in emergencies; and I accept e-mails which I check every day, but I keep my phone for personal use. Besides, the day before I had worked 3 hours later than I planned and if they had called me at the time they came afterward, and I came in because I felt guilty, then I wouldn’t have had reserve the next day. And I don’t like the idea of positioning myself as the only doctor who can help a family, especially for something simple that any clinician can care for. That family wasn’t happy, but I think they respected my reasons at the end. The same day the clinic staff wanted me to see a patient with high blood pressure, and the pressure was high, but I still had 3 patients waiting who had to see me, and I knew that the other providers could stabilize the patient as well as I could if they followed the protocol. I feel cruel sometimes, and I feel like I am escaping responsibility other times, but I want my ministry here to be a marathon, not a sprint. Praise God that I am married to a man who is not a people-pleaser, who understands boundaries and margin and sticks to his principles. God definitely had a higher purpose when he matched us up – life just wouldn’t be sustainable without Greg.
Week 76: Traveling Again
Now listen, you who say, “Today or tomorrow we will go to this or that city, spend a year there, carry on business and make money.” 14 Why, you do not even know what will happen tomorrow. What is your life? You are a mist that appears for a little while and then vanishes. 15 Instead, you ought to say, “If it is the Lord’s will, we will live and do this or that.” James 4:13-15
Traveling in Africa is always an adventure. First of all, you really become better at praying when you realize that any car, animal, bike, or person might jump into the path of your car at any time. Secondly, you never know what is going to go wrong, but the basic constant seems to be that something will. My parent’s visit marked our fifth attempt to visit Zomba. With Mai-Linh, our car arrived a month late and with only 3 tires, and it took a week to find matching tires in town. With Stephanie and Dan, we made it to Zomba, but Greg had such a bad fever that we had to abandon our 3-day trip after one night. With Suzi and Fritz, the “luxury” hotel we booked lacked hot water and a toilet seat, so we switched to another hotel for the second night and didn’t have power. With my Aunties, we popped a tire at the top of Zomba plateau, and Greg had to rush around finding a tire that sort-of matched. We ended that last trip with a 6 hour drive, half of it at night, worried first about our tire overheating (which it was by 30 degrees) and next about running out of gas (because there is a 200 km stretch with no gas stations that we always manage to forget about.”
So as we said our prayers for traveling mercies and took off, once again, for Zomba, we wondered what this trip would have in store. I for one was excited about the deal of more than 50% off that we got at the Sunbird Ku Chawe – the hotel at the top of the plateau with a spectacular view and one of the nicest (and often most expensive) in the country. Our room was spacious, the view was beautiful, there was water and power and even a toilet seat. But we soon discovered, there were also bees. We saw the first one crawling around when we first checked in. Conservationalist that I am, I scooped it up in a glass and set it outside. Then next one I discovered about 9 pm when, dancing around the room enjoying the luxury, I suddenly felt this unbelievable pain in my toe. Turns out that mini-fridge beer works as a great ice pack. And I am still not anaphylactically allergic to bees, which is good since we were an hour from the nearest medical facility with no medications. But unfortunately, when we started looking, we found two dozen bees crawling around on our floor and our curtains. It seems they sprayed just before we arrived, so while the bees were not too mobile, they were crawling right where we could find them. We couldn’t negotiate with the front desk for an even better discount, but they did offer us free ice cream on our last day. The view from the patio was wonderful, and fresh raspberries and icecream were the perfect way to finish our Zomba trip. And we had a new tale to add to our list of adventures traveling to Zomba.
There’s nothing like health issues to remind you how little control humans have over life. I should have known that deteriorating health was on the horizon when I couldn’t sleep well for the majority of last week – just too much stress. It seemed odd to me that running my usual 3 miles with my friend Marion was difficult on Monday. Then on Tuesday my stomach got so upset that I couldn’t hold down food all day, but the nice side effect was instant weight loss. I thought things were better by Wednesday, but then I started coming down with a sore throat and runny nose. That got better by Thursday, but then the upset stomach came back with a vengeance. By Saturday I was vomiting up a storm before and during the health walk. I was very disappointed that the nausea medication that seemed to work so well on the majority of my patients did nothing for me. I slept so much after that, but still not much better by Sunday. So I finally caved in and started taking some antibiotics. It is so much easier for me to prescribe antibiotics for others than to decide which to take myself. They say that doctors make the worst patients, it’s just that I second-guess myself, what I am likely to have, how long it is likely to last. Then there’s the part of pushing myself – traveling to see friends throughout the weekend, going into the village with my parents during the week – maybe we doctors just expect more out of our bodies at the expense of expedient healing. Well, if nothing else, this is a poignant lesson on how to take things a bit slower and take care of myself a bit more.
“As a prisoner of the Lord, then, I urge you to live a life worthy of the calling you have received.” – Ephesians 4:1
On Thursday, Madalo taught devotions. The day before, I spoke, cross-referencing teaching on prayer for healing from Hezekiah’s story in the Old Testament with James in the New Testament, and how it all comes down to giving God the Glory. I think that a few people got something from my sharing, especially in contrast to the prosperity gospel so often preached in Malawi. But Madalo, our charge nurse, was a bit more direct. She passed out post-it notes and asked us to write down how we wanted to be remembered at the end of our lives. It wasn’t an easy task, and when we didn’t want to say out loud what we wrote, she challenged us that if it was this hard for us to share how we wanted to be remembered, then how much harder would it be for our families to honor us after we go? Then she shared that her goal is to live up to her name, which in Chichewa means Blessings. She wants to be remembered as someone who is a blessing to those around her. As a nurse and a hardworking, friendly, outgoing individual, I think that she is well-positioned to do just that. Then I thought about my name, Christina. I always thought of it as meaning Follower of Christ, but Greg says that the translation is more like Christ-Bearer. I hope that I can be one who bears Christ’s name to my patients, my coworkers, my neighbors, and my family.
It’s funny that Moore says that Christians was originally a word used in ridicule for believers, but how Peter admonished the early church to bear the name well. Hearing Scott Daniel’s sermon about being Children of God and Reading Ron Mehl’s book about the commandments today helped me realize that we risk using the Lord’s name in vain, in a way, if we are not worthy of the calling we have received. It’s been a very stressful week, a time of working through disappointments and personality conflicts, so the reminder and re-centering couldn’t have come at a better time.
Week 73: Heaviness
“Listen, my beloved brethren, has God not chosen the poor of this world to be rich in faith and heirs of the kingdom which he promised to those who love him?” – James 2:5
I carry the burdens of my patients with me long after I leave the office - even day to day I feel weighted down by the secrets and life-shattering problems that these people have entrusted to me. The American twenty-two year old who was attacked by her boyfriend and concerned about HIV. In the absence of support groups and counselors, I tried to listen and help her with a plan for moving forward. The Malawian 32-year old with tremors, vision problems, and intractable vomiting as he suffered alcohol withdrawal. I received calls day and night about medications to keep him from having a seizure and pleaded with him and his family to abstain from alcohol for the rest of his life before the next admission becomes the rest of his life. The English NGO worker who developed uncontrollable anxiety that plagues her day and night. She didn’t want medications, so I tried my best sharing books and web resources. The young Malawian with sickle cell disease and an infected hip so necrotic that the surgeons told him he had to live with it until he eventually dies from it. It took a bit to convince the other clinic staff that his requests for the equivalent of one Vicodin every six hours for his severe pain was not drug-seeking behavior, and I hope I’m helping him rather than harming him. We talked about what was most important for him in this life, how he wanted to live with the time he had. Just like I tried to share options with the student who came to me with stomach pain and ended up having a positive pregnancy test. I pray with patients and give them my e-mail for continued care, but at the end of the day, I carry their stories and their hurts with me. I try to stretch and run and take warm baths and massage out my tense muscles, but try as I might, my shoulders are up around my ears more often than not. Sometimes I can’t relax those trapezius muscles no matter how hard I focus on them and try. Today my lower back doesn’t hurt, which is a bit unusual for me these days, but I have this muscle spasm in my left neck that hurts when I move or breathe. My best buddy from medical school tells me that I carry all the stress in my body. He even sent me acupressure dots, massage balls, and relaxing oils. But at the end of the day, I’m a long way from the apostle’s admonition to “be anxious for nothing but in everything by prayer and supplication with thanksgiving let your requests be made known to God, and the peace of God, which surpasses all understanding will guard your hearts and minds in Christ Jesus.”
Week 72: Tea on the Porch
“Beloved, let us love one another, for Love is of God, and everyone who loves is born of God” 1 John 4:7
Sometimes I think that I am most human when I am on my porch. Sure, I spend most of my time in the clinic trying to bring healing or on the computer trying to pull things together, or on the couch relaxing, but it is outside, on my porch, when I can just look out at the sub-tropical greenery and be present in the moment. When the sun hits them just right, there are two solar powered water fountains that just bubble away, adding to the ambiance. Sometimes my dogs join me, and that is fun to have them at my feet while I am out there reading or sipping tea. And the porch is a place where I can invite others to join me in my timeouts from the chaos of life. Even if the house is a mess, or even if I have no food to offer a visitor, the porch is always intrinsically nice, and there is always some exciting tea to share. The visitors don’t even have to brave the dogs if they don’t want to. Last week, I started out with a wonderful Sabbath napping with Greg and the dogs on that porch. Then our South African neighbor came over, challenging Greg to chess and enjoying some Dragonwell from China along the way. On Monday, my friend the Infectious Disease doctor from Italy brought over her infant and a box of cookies from Mozambique. On Tuesday my Malawiian pastor friend brought her niece with a medical issue and we mixed sugary rehydration solutions to help with her treatment. On Wednesday the English doctor from across town came to learn a bit about my preventive medicine lifestyle consultations, and we finished the session sipping black tea from Paris alongside a veggie platter. On Saturday I was back on the porch sharing bubble tea with my fellow ABC missionary from South Korea. And on Sunday I was back on the porch with my husband and my dogs, listening to the fountain, reading my books. I do love the pace of life here, sharing a flower and a cup of tea with my friends. Where else in the world could I have experiences and interactions like this? Where else could I have the space to just rest and enjoy these types of experiences?
“You are not that important… God can do this with or without you…You need to trust your God…” – from a Missionary doctor in Kenya
His acute kidney failure and unmeasurably high sugar levels took longer than usual to control, and after his second admission in two weeks, it was clear that his diabetes was not going to be controlled on pills alone. Surprisingly, this was my first patient since coming to Malawi who was going to need insulin. He wasn’t in a rush to start the medication, and I wasn’t in a rush to make him pay out of pocket for the treatment, so after consulting with the nurses, we recommended that he go to the Diabetes Clinic at the central hospital in 4 days to get started on the medication. I instructed him about drinking 2 liters of water daily to prevent dehydration and kidney issues, and to eat only vegetables instead of sugar-increasing carbohydrates. Then I went to Kenya. And when I returned to clinic, I heard that he had died the morning he was supposed to go to the clinic. I knew that his situation was the most severe I had seen in ages, but he improved so much from the first hospitalization to the second, and at the time of discharge he was doing really well. So I was shocked and saddened. I tried to find out what happened, but neither the providers who had been working that week nor his family member who worked at ABC knew exactly why he died at home that day. As rewarding and incredible as it is to be a doctor and as great it is when God works His healing through me, this position sure reminds me of how little control we have in this life, even when we think we have the tools and knowledge to help. One of our speakers at the conference mentioned that our battle is not against physical death – God has already won that battle – instead, our battle is against powers of darkness in this world, and we have a guaranteed victory there as well long-term. “Some of my patients will die before me” she shared, a tough realization for a pediatrician, but no easier to stomach for me. I pray that I can continue to be faithful with my vocation, bringing hope and healing when possible, learning from mistakes, but not allowing myself to feel each death as a personal defeat. “Where, O death, is your victory? Where, O death, is your sting?”
The time we spent in Masai Mara National Park felt like a dream. It was so different form the other safaris we had been on. Wide open plains, so many elephants, antelope, and buffalo. We saw a Cheetah! It was so incredible, even chasing after a gazelle. We also saw lions and giraffes, all within just 90 minutes of entering the park. But we only had about 3 ½ hours in the park total, maybe that is why if felt so much like a dream. We boarded our flight in Malawi at 3 am (Harry drove us to the airport at that hour and wouldn’t even accept a tip). We cleared immigration and walked through customs, and Onesimus picked us up in Nairobi at 7 am. We drove the 6 hours to the park, ate lunch, napped a couple times, and went on a spectacular afternoon safari. The subsequent morning safari was truncated by a couple flats brought on by Onesimus’s aggressive and much-appreciated driving that got us amazing pictures. But by 9:30 we were on our way again, passing buildings that we slightly recognized as we listened to books on tape. We arrived at Naivasha at 2:30, in time for a late lunch and fun fellowship with friends who are oh-so encouraging. It was so nice getting to the conference on time, compared to last year when our time here was truncated by difficult travel and expensive flights. I wonder that we don’t get tired of safaris even after we have been on so many. Maybe this is part of what we were created for – enjoying animals in a garden.
“A hundred years from now it will not matter what my bank account was, the sort of house I lived in , the kind of car I drove… but the world may be different because I was important in the life of a child.” – Forest Witcraft
I never thought I would be running in a track meet in Africa. And boy am I sore the day after – we participated in an ABC college Super Saturday events on the “track” on Saturday – which was really the soccer field and distances were estimates. It is amazing how muscle memory and competition can push you beyond what your 30-something body really should do. I placed second in the “Marathon” which was really about 1.5 miles, but then I ran the 100m, 200m, and the 4x100 relay. I got third in the other races and the faculty came in second overall, just behind the second-year students, but it was fun to watch Greg run and to be in a relay with him again. The rest of Saturday was so full – meeting with Thoko and Nixon, driving to the village to bring a sick child back to the hospital for admission, dressing up for Charlotte’s 16th Birthday party (60’s themed Karaoke). Not many weekends are as full for us as this one, but the last few days have included a pot luck, an international food festival, visiting a new church, meeting with our area missions directors for burgers and ice cream, planning for next week in Kenya, and all the while trying to make sure that the child we admitted to the hospital was doing OK. I don’t know what I thought life in Africa would be like, but this richness of activities certainly never came to mind. I hope we can balance the busy schedule with time for rest, and focus on things that further God’s kingdom. But I do love how Greg and I can still run together, whether it’s a track meet or just sprinting with our dogs.
“The whole biblical teaching is rooted in relationship. Money has ultimate meaning only if it enhances human relationships.” – Kosuke Koyama
We were a few minutes late to church on Sunday because it looked like rain, and so we decided to puppy-proof the house rather than locking the dogs outside and dealing with the resulting muddiness. It turned out that only one other family had arrived, one of the leaders of the Nazarene College in town. We chatted outside for a bit, because the door was locked and nobody seemed to have the key. A few minutes later our District Superintendent, who serves as the pastor of our small church, arrived with his family. After some research, it seemed that the guard had left the door locked and left the premises. So we worshiped outside that morning, with off-key Chichewa and English songs from the hymnal, an awkward offering with all of us sitting in a row on the brick wall in front of the pastor, and a nice homily from the pastor. Towards the end, it started to sprinkle, and we prayed and parted right before the rains started coming down. It was a nice, intimate gathering, the sort that seems only possible in Africa. We continue to pray for our church, that building with so much potential but so many stressors. And that sometime soon we may find where we fit in the community here, what we can build and how we can make an impact.
This week was bookended by patients I met Monday and Friday who died before I saw them again the next mornings. When I met them, I could tell by their vital signs that their illnesses were serious, and that they were weak. But at first it seemed there was hope, that there was plenty of time. I never really spoke to either of them, they were struggling to breathe, the oxygen wasn’t enough, and they were tired and disconnected already. So while I did all that I could for their conditions, it seemed like it was the families who I was mostly caring for. On Monday we struggled to find a facility with an open ICU bed, a bit of a feat with only 10 ICU beds available for a population of millions of persons, and even then one couldn’t guarantee there would be enough oxygen to go around. I wondered if I should have done more to prepare the family for the increasingly likely possibility that the patient might not do well. But I was surprised when, even in the ICU, he didn’t even make it one more day. On Friday things changed quickly over a matter of hours in the afternoon. I tried to delicately advise the family of possible outcomes, without making it seem like I was taking away their hope or not honoring their loved one. We called our chaplain, who is also a nurse, early in the evening to help prayer for the patient and her family in a culturally appropriate manner. Five hours later, she passed on. One of my nurses said she seemed ready, having lived 40% longer than the life expectancy in Malawi, but I wonder whether her family was ready, whether we helped them during this excruciating time. Even ten years after I started studying medicine, it still amazes me how a doctor is rushed into the most critical moments of a person’s life, of a family’s struggles. I pray that I can honor that trust, that I can “live a life worthy of the calling,” that I can remain centered in the hope that I have even during the difficult days.
Week 66: Comforts
“She extends her hand to the poor, yes, she reaches out her hands to the needy.” Proverbs 31:27
“Man can neither make, nor retain own moment of time. It all comes to him by pure gift. He might as well regard the sun and moon as his chattels. He is also, in theory, committed to a total service.” – CS Lewis, Screwtape Letters
CS Lewis talks about how none of us really own anything, and in fact if we realized that God owns all our time and our very selves, we would be thankful to spend entire days in whatever He asked of us. Much like the Sermon on the Mount, “Who of you by worrying can add a single hour to your life?” I’ve spent a lot of time in the Sermon this week, reading and re-reading it. It challenges me. Much like how Bonk’s Missions and Money affronts and festers within me. My standard of living truly is above the majority of the world and it is hard to even conceive of giving up any comforts that separate me from the lives of those with whom I want to share the good news. How much of a hinderance to the gospel will that be? “Give to everyone who asks you.” Yes, but here in Malawi people ask all the time. Are we really called to empty ourselves of all earthly possessions? “That is what pagans are always looking for; your heavenly Father knows that you need them all.” Innocence Magambi in his Refuge for Life talks about the pain and frustration of being friended by foreigners and not being helped in spite promises. It’s hard to feel like our key role in relationships is being a source of money to others, but how else can we connect to locals? How can we see need and not act? One year ago, Givemore our ambulance driver taught me that Muslims were regarded as more generous that Christians, who with their Protestant work ethic and hard lines for sustainable ministry hold money back from people. I used to think that it was easier to be a Christian here overseas, because being in a different culture reminds you that this world is not your own. But here we are confronted with our own desire for comfort and apathy for the plight of others, and unwillingness to share some things. I suppose it is not worse than being in America and just ignoring these facts. But how many of us will be among those who hear “I was hungry and you gave me nothing to eat.”
“It is simply no good trying to keep any thrill – let it die away – go on through that period of death into the quieter interest and happiness that follow – and you will find you are living in a world of new thrills all the time. But if you decide to make thrills your regular diet and try to prolong them artificially, they will get weaker and weaker, fewer and fewer, and you will be a bored, disillusioned old man for the rest of your life.” CS Lewis, from Mere Christianity
“The beauty of doing nothing is the goal of all your work, the final accomplishment for which you are most highly congratulated. The more exquisitely you do nothing, the higher your life’s achievements.” – Elizabeth Gilbert, from Eat Pray Love
Well, I didn’t exactly do nothing this week. We drove for 34 hours, listening to audiobooks to keep us going, as we went the length and width of Zambia and back. We spent 36 hours on safari and saw over 100 species. But I slept a lot, took naps and got a massage by the river, and didn’t worry about being productive, not even reading or going online. I drank lots of tea, saw animals, went to tourist destinations, and enjoyed my 32nd birthday with tea at the Royal Livingstone. Compared to last week, which was driving every day and a different type of lodging every night, we stayed 3-4 nights at each place, except Lusaka, which was 10 hours on the way there and 12 on the way back. We liked going to Pizza Hut in Lusaka and joked about going back every weekend. But realistically, that might be the last time we decide to drive it. We were ready to come home, but it really was such a fun trip.
Week 64: Tour
“Culturally speaking, Americans have an inability to relax into sheer pleasure. Ours is an entertainment-seeking culture… This is the case of the great sad American stereotype – the overstressed executive who goes on vacation, but who cannot relax.” – Elizabeth Gilbert, from Eat Pray Love
This trip really helped me appreciate my husband, how he can drive for hours on difficult roads not getting stressed about the pot holes or pedestrians too close to our side. How he can cuddle with me on a slightly deflated air-mattress which a 12-year old prepared for us so we could stay with her family while our aunties were in an overpriced tea estate down the road. How he was able to go down Zomba mountain on a donut and find a tire that matched ours to replace a flat and be back before Auntie and I finished our hike to the waterfall. How he drove up Thyolo mountain to bring us a picnic lunch, and took a woman carrying a basin full of nsima along the way to help her have a better day. How he brought books and books on tape to our friends’ children, how he lets me do crazy things like climbing trees and trying to squeeze through breaks in the window to get into the CCAP, how he encourages me even when the price of the berries and ice cream or the picnic lunch were a bit much because we can enjoy the view and do something for the Aunties. We had quite a drive yesterday, praying that the tire pressure and temperature would be OK, and then after the sun set, praying that we wouldn’t hit anything on the dark roads, then finally, in the last 50 km from home, praying that we would not run out of gas before we made it to the gas station. Aah, what a pleasure it is to be partnered with someone who can help me through adventures and pray through hard times with me.
“You are worthy, our Lord and God to receive glory and honor and power for you created all things, and by your will they were created and have their being” – Revelation 4:11
I was so excited for Auntie Gayle and Auntie Judi to come. It was hard to finish up work, we were short staffed and I was just itching to be done. I worked on a schedule for future meetings of provider Continuing Professional Development and typed up notes with even more algorithms and step by step instructions to help with outpatient diabetes and hypertension to prepare for being gone. I ran with Marion, bought books for the Blanchards children we would be visiting and did laundry. Ishmael helped make everything look nice. Greg bought lots of essentials and prepped the car and paperwork for the journey. I thought the time would never come, but finally, it did and I was off work! We greeted our Aunties at the airport with their favorite beverages and the fun began. We enjoyed good food, exciting places, a bit of rain and lots of beautiful, clear skies. I am amazed that we didn’t miss any reservations, that things have gone well so far. And the Aunties seem to have enjoyed the time – from the down time at Norman Carr to the cultural experience at Cape MacClear. Even some amazing memories like getting stuck in the rain at Satemwa and having a baboon come into the room right beside Auntie Judi at Ku Chawe. We have been tired from all the traveling, most nights Greg and I slept 10-12 hours. It’s been a very enjoyable, exciting experience so far. No internet all week, though. And that is kind of nice in its own right.
“But if we walk in the light as He is in the light, we have fellowship with one another, and the blood of Jesus Christ His Son cleanses us.” – 1 John 1:6
We planned a health walk this weekend again. Disappointed at low turn-outs in the past, I e-mailed 23 patients the day before. Someone posted it on social media and What’s App groups, but I arrived in front of the clinic at 6:00 am unsure of whether anyone would show up – even our charge nurse Madalo was a bit sick and didn’t have a car, so she texted me that she was late because she was walking 45 minutes to get to clinic. I wondered if I should have skipped and slept in myself. But to my surprise, over 100 people showed up to walk together with the clinic staff! I couldn’t believe it, at first I thought that people were there for some other get-together. There even were about 50 that wanted to go right at 6:00 without waiting for others to do BP checks beforehand. I was so grateful that a patient the week before had donated so much water - his 80 bottles were gone in a flash – people walked 9 km with them and were so glad to have them. It’s surprising how hot and high the African sun is, even at 6:30 AM. I jogged between groups of walkers, chatting with them and asking if they had any health-related questions. I ran up ahead so I finished right before the first group, they were fast! I did a short stretching routine, maybe just 5 minutes, with three sets of groups as they came in and got great pictures. Everyone wanted to know when the next walk would be, so we tentatively set it for the 3rd Saturday of every month. I was so enthusiastic that afternoon, I wasted no time setting up a Healthy Lifestyle Facebook page for the clinic and the city. I hope that this can spread health and healing to the community. It feels like I am finally doing something, finally connecting to people in some sustainable ways!
“And the prayer of faith will save the sick, and the Lord will raise him up. And if he has committed sins, he will be forgiven. Confess your tresspasses to one another and pray for one another, that you may be healed. The effective, fervent prayer of a righteous man avails much.” – James 4:15-16
The 72-year old patient didn’t seem critically ill on Wednesday, he had slightly high sugars, which is why the clinical officers consulted me, and when we looked closer, it seemed that a urine infection was causing most of the trouble. On Thursday his son was concerned that he wasn’t eating, so we decided to admit if he didn’t perk up. By Friday, an officer admitted him – by then he was on oxygen, I’m not sure why. One of the family members was a physician, but when I asked who should be involved in a family meeting, he was not one of the four invited in. I explained along with the clinician that the case could get better or worse, that we were committed to his care, but as a community clinic we did have limitations when it came to care over a holiday weekend, limitations such as no doctors on call. They assured us that they would never think of bringing their loved one elsewhere. I was slightly less that reassured. We prayed for healing, convinced them to let us re-start the intravenious antibiotics, the strongest we had, and instructed the nurses to watch his vital sighns closely. I didn’t receive a call that weekend asking me to come in and evaluate the patient, so I was almost afraid to ask how things were when I returned to work. The clinican on duty told me he had died before she even reported to work on Saturday. It happened so quickly. I saw the signs, he didn’t want to eat, was growing weaker, and then he started having difficulty breathing. We treated him with the strongest antibiotic we had, but he just couldn’t recover quickly enough. 72 is more than a decade above the life expectancy in Malawi, but I wonder if the patient was ready to go. I had tried to prepare the family for that possibility, but I fear that I wasn’t culturally sensitive enough, that they didn’t understand why I had mentioned another facility for escalated care, why I didn’t think that electrolyte tests would help. I read an article this week in the Christian Journal for Global Health where James Ritchie talked about these situations: “for a Christian, earthly death, the first death, is not our enemy. It is not a failure, not a lost battle in which the Devil won, not a catastrophy that the non-believing eyes might perceive. Then end of earthly life is garanteed, decreed by God.” There have been many miracles here in Malawi, times where God has honored prayer and patients have recovered quickly. And times when patients deteriorate quickly and we hope that we have fulfilled our calling to the best that we are able. “Because ‘all flesh is as grass, and all glory of man as the flower of the grass. The grass withers, and its flower falls away, but the word of the Lord endures forever.’ Now this is the word which by the gospel was preached to you.” Oh, that I could become better at helping patients and their families prepare for that ultimate transition that we try to avoid like the plague, but which will happen to 100% of all patients, everywhere.
Week 60: Rains
“For the earth which drinks in the rain that often comes upon it, and bears herbs useful for those by whom it is cultivated, receives blessing from God.” – Hebrews 6:7
This week we had a heavy storm – the rains just poured down and branches fell off the trees. We were so thankful for our strong brick house, but all over the city, there was flooding and devastation. Walls fell over, roofs fell in. A sheet of metal fell upon a woman’s foot, and she came to the clinic with three toes disconnected. On Sunday morning our church was so flooded that we had our service in an upper room that I didn’t even know existed until today. The pastor told me that farmers who had earnestly prayed for rain earlier in the week found that their crops were washed away by the heavy waters. Every time it rains, I am reminded how little humans can influence in the natural world. For all our science and technology, we cannot bring forth the rains like God does, nor can we control them once they come. As for us, we have comfortable resources, so we can enjoy the rains with relatively little worries - our dogs loved splashing through mud puddles and I enjoyed sitting on our porch, enjoying a nice cup of tea looking at the downpour, but so many are at the mercy of the weather, especially in sub-Saharan Africa.
Week 59: Support
“Now godliness with contentment is great gain. For we brought nothing into this world, and it is certain we can carry nothing out. And having food and clothing with these we shall be content.” I Tim 6:6
This week was tough. One patient was bleeding pints of blood out of her gut as a medication side effect. And another couldn’t get enough oxygen into her blood because of an old TB infection that didn’t seem to be appropriately treated. A woman I saw last month returned after getting an MRI in South Africa, and I was shocked to hear that she had a stroke in the balance center of her brain. I knew she had some issue with her brain, but I didn’t realize her dizziness was linked to that. One woman looked up at me from her wheelchair and asked what I would do if I was her and afraid to get an HIV test because it was certain her husband was cheating. I talked to her a bit about her options, and gave her the number of our chaplain, who I hope she sees. That was all on Wednesday. After all that, I felt like I could barely drag myself home at the end of the day, so I took my first sick day since I started working at ABC clinic. I slept in and took two naps that day. I read on the couch, drank lots of fluids, and massaged my neck which suddenly started hurting (Greg says that I get a neck spasm whenever some other part of me tries to relax, like I am just a wad of tension that gets off balance if I rest). I was feeling better, but not completely improved by Friday. And that was when we were called in for a meeting about what to do about the cholera that had broken out at the village across the street from us. We had a confirmed case and two suspected cases in our treatment room, but no infrastructure for quarantine or handling large numbers of people who would come. Just that meeting was so overwhelming, I wanted to go home and take another sick day. But I got through Friday and had a great refreshing weekend. And so far, the cholera has been contained at the village level with no additional cases referred to us. But now I’m refreshed and ready to tackle another week, whatever the challenges.
Week 58: Show Love
“Now the purpose of the commandment is love from a pure heart, from a good conscience, and from sincere faith.” – 1 Timothy 1:5
Greg and I sat on the porch, listening to the flow of our fountain, dogs at our sides, drinking in the beautiful sunny day. Greg bought me 20 roses and a box of truffles. I put 8 of them on a plate to represent our 8th Valentine’s Day together- they didn’t last long. So much of what we enjoy now wasn’t even a part of our lives a year ago – our house with its porch and rose bushes, my garden, the patio furniture with the cushions made by Thoko, the dogs who are finally starting to listen to us, the critter habitat that Greg made from the old bathtub and the Spencer’s rocks, our car that takes us on fun dates, even the extra strawberry plants that are growing from sprouts. This time last year, I didn’t have a Malawi license, a mentor, or a place to work, and Greg didn’t have his PhD yet, he hadn’t even done his defense. Emotionally and financially we have been blessed so much this year. I moved my things into my own exam room this week, and even though I got a bit burnt and tired walking back and forth from the dental building, I loved having my own space for the first time in the 10 years I’ve been in medicine.
I got plenty of naps and runs this week and started drinking lots of water. I picked up a new book about Malawi and have enjoyed that. I talked to Karese about things that we enjoy, and she encouraged me to take pictures of things that make me happy, like flowers, so that I can enjoy them even after they pass away. Life is really good right now. God is teaching me a lot about not stressing about the future. With a present this enjoyable, I think that’s easier than usual for me.
“And may the Lord make you increase and abound in love to one another and to all, just as we to you. So that He may establish your hearts blameless in Holiness before our God and father in the coming of our Lord Jesus Christ with all His saints.” – 1 Thessalonians 3:12-13
This week was a bit exhausting – there were a couple days when I didn’t get a lunch break until 3:00 and other days when I was running up and down the halls because there wasn’t an exam room available for me. Overall I saw some of the most patients I have in one week, and worked some of my longest hours since coming to Malawi. I’m still happy to be here, and amazed at how dramatically the patients improve, but I did get a bit sick this week, probably from overworking and lack of sleep. Greg came to clinic with me on Tuesday to take some pictures for a blog piece that Samaritan’s Purse wanted to do. It ended up being really nice because I was able to e-mail back some pictures to the patients’ families, who probably don’t get much of a chance for family portraits. Greg helped me fry up churros for the weekly potluck and it was fun to work together on that Friday morning. I ate a lot of them for breakfast. Then I used the leftovers for cinnamon roles which I thought turned out Ok. I’m excited to have the rest for breakfast tomorrow. I spoke at the CHIP program again last week, (a healthy eating program) and I still have a bit of a tough time reconciling whenever I eat foods that aren’t the healthiest. Greg talked at the Nazarene College tonight and I wonder if he will speak for them a bit more, and if that will help us get plugged in with the local teaching community. I know that God has really directed every single transition in my life up until now, so I trust that he will guide us in the future, but it is hard not knowing, and not even having a vision or a clear goal for the future. But I guess this is part of what God is teaching us during this time as well – how to be faithful in the present even when we aren’t sure of the future.
Week 56: Sunday Morning
“Whatever happens, conduct yourselves in a manner worthy of the gospel of Christ” – Philippians 2:7
When we arrived at church, every seat was filled. Ever since the robbery last fall, when all the chairs were stolen from Ufulu Church of the Nazarene, the church had been borrowing a few chairs, about 32, from the school that rented its facility. But there were more people than usual this morning, probably because a van had taken a few students from the nearby Bible College. So one visiting pastor sat in the back on a bench. After some hymns, Greg was asked to pray an opening prayer, and to pray especially for rain, because there had been less rain in Malawi this year, and the maize crops feeding the rest of the country were at risk. By the time he finished the prayer and the message had started, there was such a downpour on the metal roof of the church that we had a hard time hearing our preacher, even when he was standing right in front of us. The pastor in the back moved his bench to the front, beside our preacher, in order to hear better. As I was sitting there thinking of how much I loved the rain, Christine Tshebemba, another pastor’s wife and a refuge from the Democratic Republic of Congo who had just been allowed to leave the Dzaleka refuge camp and live with her husband again, handed her six-week-old son to me to hold for a while. Eveness, a student from the Bible College, helped shift my hymnal and bible out of my lap so that I could hold the baby, who’s name was Gold. He was perfect, either resting against my skin or looking up smiling at me. Eveness helped me find the passages in the Bible and the hymnal, but I have to admit, Gold was so sweet, it was a bit hard to stay focused on the sermon. I am so blessed with a church that sees us as family, and really happy to be in Malawi during this time of my life.
Week 55: Sight to the Blind (January 30, 2018)
“Jesus answered and said to them… The blind see and the lame walk; the lepers are cleansed and the deaf hear; the dead are raised up and the poor have the gospel preached to them.” – Matthew 11:4-5
I first met the patient one month ago, when he was admitted to the hospital with a new diagnosis of diabetes and sugars so high that they were unmeasurable by our machines. His sugars were slightly better by the time he was discharged, but even a week ago on maximum dose of one pill, his fasting sugars were still twice normal. He was young, maybe his late 20’s, with a lovely wife and a young baby. His vision, which he said had improved, was still worse than 20/200 –he was legally blind and he couldn’t read a thing on my pocket vision card. I sent him to the optometrist and then the ophthalmologist, but besides his diabetes, which was already improving, there was no sign of what was causing his blurry vision. Today he was eager for me to test his eyes again. I was a little skeptical at first, but it turned out his vision was 20/20, just a week after he could barely see at all. And his peak daily sugar was down to 156, which is probably better than mine, and his kidney function had improved to normal. I’ve had enough patients at this point to know a miracle when I see one. I couldn’t explain the blurry vision, neither could the ophthalmologist. He didn’t have cataracts or infection, and how could a sugar of 250 explain vision that bad so suddenly. Improvements like that just don’t happen in America. I wonder if I’ll ever be able to practice in a developed country again, where people just seem to continue with the same illnesses their entire lives. It’s amazing to be part of miracles here and to see such incredible transformations.
Week 54: Connect with Others
“For all the law is fulfilled in one word, even in this, ‘You shall love your neighbor as yourself’.” Galatians 5:14
“And today God keeps on loving the world. He keeps on sending you and me to prove that he loves the world, that he still has that compassion for the world. It is we who have His love, His compassion in the world of today. But to be able to love we must have faith, for faith in action is love, and love in action is service.” - Mother Theresa
This week, I felt so fulfilled by my job, like I could really feel God’s healing power pouring through me onto patients, through no merit of my own. There was one day where I saw patients with miraculous healing of blood pressure, kidney issues, and control of diabetes in ways I would not have expected. Things as simple as a newborn with constipation healing with the tiniest bit of medicine and a young man with a skin infection of his arm finally improving after getting worse in spite of our strongest medicine. The days were joyful, rewarding. With each patient, I felt like this was a vocation, a calling, not just a drudgery to come to work. On Friday we went to a missional talk at Partners in Hope. It echoed some of the things I had been feeling in terms of work in healthcare in Malawi being a calling and a ministry, not just a job. I noticed that I can see the same number of patients here in Malawi as I used to in America, but I don’t feel drained, I feel like I’m making a difference. I really admire Mother Theresa as someone who died to herself daily and habitually financially, socially, physically, and even spiritually. I hope that God does not call me to a life of that much abandon in order to fulfil His call on my life, but I can’t help but admire her impact, as one aboriginal shared, “Tell Mother, my friend, the light she lit in my life is still burning.”
Week 53: Be Faithful
“Since we have these promises, dear friends, let us purify ourselves from everything that contaminates body and spirit, perfecting holiness out of reverence for God.” – 2 Cor 7:1
This weekend, I was so content. On Saturday I ran with the dogs and had a nice breakfast with Greg and sat on the porch watching the birds, garden with roses, and the fountain. I was able to read to my heart’s content and just rest. Life is so peaceful and there is so much leisure and freedom here. Dad says it might be the first time in my life that I have this kind of ability to delve into hobbies. Well, at least the first time since elementary school.
On Tuesday during devotions, someone asked that we pray for rain because there had been none for 10 days and some crops were in danger. Diane suggested that request be taken by someone who had a garden, but then we sat there awkwardly for a few minutes with nobody speaking up, so I raised my hand. Someone asked in surprise, did I have a maize garden. I said no, but I had tomatoes. I prayed for rain, not too much, but just enough, and was reminded of how God’s blessings were revealed so much in rain, which man has so little control over. The rains were sprinkling by the time we finished devotions and pouring by the afternoon. Later, people joked that I could be a prophet, and asked for me to pray for more rain later in the week. Ahh, it’s hard to be able to bask in God’s blessing and not just expect Him to bless us the way that we want.
Week 52: Reflect
“When you come to one of the many moments in life where you must give an account of yourself, provide a ledger of what you have been and done and meant to the world.” Paul Kalanithi, When Breath Becomes Air
“Whether then you eat or drink, or whatever you do, do it all to the glory of God.” – I Cor 10:31
Exactly one year ago, we navigated the OR Tambo Airport and awaited our flight to Malawi. When we landed, we were thrilled to have our bags, someone to pick us up, to see all the green and imagine the future. This year, so many things were similar, down to the weeks preceding filled with rest and good food. It feels like time flew by overall, and sometimes in spite of everything I think we’ve been discouraged at how far away long-term sustainable ministry seems. But what do I really have to show for the last year?
I have learned how to be a more supportive wife. I have been a friend who goes on runs with others and visits them when they are sick. I have been more patient, more introspective, less stressed, less lonely. I have also been tired and impatient and disillusioned. I have been a source of financial aid and a hand of healing and encouragement to some. I have turned away others. What have I meant to the world? I think that I helped at the clinic a bit, and people on campus feel better having me here. I have given information not only to patients but also churches and schools and the post office. People have said that they never knew about eating healthy. What have I meant to the world? I think that just by being here, just by sending updates, we do encourage some people. For the first time in a long time, I feel like we are establishing roots. True, we don’t know how long we will stay in Malawi, and we don’t even know how long we can stay at ABC, maybe not any beyond the 2 year mark.
I like who I am at the end of this year. I like where I am. I like who I am with, the chances to connect to people, the chances to improve myself, the chances to help people who really need healthcare. When it all comes down to it, Greg and I agree, whether we have 1 or 20 or 50 years left, we wouldn’t do anything different career-wise or even financially. I think that is an incredible thing to be able to say.
Week 51: Refresh
“Your Place in heaven will seem to be made for you and you alone, because you were made for it – made for it stitch by stitch as a glove is made for a hand” – CS Lewis, from The Problem of Pain
At the end of the year, I never feel quite ready to throw in the towel and admit that another year is finished. This year is the same, it feels like it just flew by. I know that Greg and I have done a lot – flown to the other side of the world, settled in, made friends, plugged into a church, and tried to figure out how to use our positions and giftings to help others. I’ve really been glad that I could grow a lot this year – I read some great books, and between that, prayer ministry, cooking and baking, and Chichewa, I feel like I am growing in a lot of different directions. In the future I think I would like to expand some skills, but I am glad that I used free time this year to spend time with Greg – date nights and 5-minute massages were great. We’re trying to visualize our future ministries and position ourselves to make long-term impacts, and I think it has been surprising how long that is taking, how things aren’t just fitting together easily.
Week 50: Finish Strong
“Never be lacking in zeal. But keep your spiritual fervor, serving the Lord.” Romans 12:11
The Psalmist wrote “Yet for your sake we face death all day long.” Both he and Paul who later quoted him were talking about their own deaths, like a sheep being led to the slaughter, but when I think about some days working in healthcare in Malawi, I can’t help but feel like this verse resonates how our team of providers are facing death all day. One patient last week was about 300 pounds and only 35 years old. Four of his co-workers carried him in, his, corpulent body slumped down just inches from the floor. He was drowsy, but responding to sound. He fell down at work, it seems, and nobody knew why. His blood pressure was dangerously high at 220. We administered a decent dose of IV blood pressure medication, and even though we waited the appropriate time for the pressure to go down, it still stayed about twice normal, above 200. We checked and found a mild infection and an acute kidney injury, but he was getting plenty of oxygen in the blood, normal sugar, and we saw no definite reason for the sluggish responses to our questions. The family tried to contact his primary care doctor because they knew he had some sort of heart condition, and until I knew the details of that, I didn’t feel comfortable adding too much oral blood pressure medications. And after an hour, neither his blood pressure nor his responsiveness was improving. We planned to transfer the patient to Kamuzu Central Hospital, where specialists could look into his heart and kidneys. Before the transfer, we re-opened the discussion with the family about obtaining a CT scan, and they agreed to spend $120, the equivalent of three month’s salary for a day laborer, to obtain a CT scan. When I reviewed the images, there came a mix of relief at finding a diagnosis and a sickening dread over the prognosis. The patient had a sub-arachnoid hemorrhage, a rupture of a blood vessel inside his brain, leading to a stroke at his young age. The family already contacted the one neurosurgeon in the region, I’m not sure how they had her number. She agreed that the diagnosis was one of the worst possible, but that they would examine him if we transferred him as quickly as possible. At first our team was concerned about the transfer – we had just tried to transfer a child, a victim of poisoning, during lunch, and KCH revealed that they had no oxygen cylinders left, so we left our single transport tank with him until it ran out. KCH told us not to send anyone else unless we brought oxygen too. So far, he hadn’t needed oxygen, we just had him on it preventively. And the surgeon wanted him there quickly, so we sent him off. I tried to comfort his father and sister, I knew this must have been quite a shock for them. It wasn’t easy for me, realizing that I couldn’t do much more besides offer prayers for a miracle. I guess that’s why I specialize in preventive medicine so much, so that I can help and reverse risk factors while there is still time. But between this patient and the others who I have seen slip away, it is hard to resonate with Paul’s conclusion: “No, in all things we are more than conquerors through him who loved us.”
Week 49: Support Others
“Therefore encourage one another and build each other up, just as in fact you are doing.” – 1 Thessalonians 5:11
Our two Malawiian pastor friends were having trouble getting sleep because villagers kept knocking on their door all night asking for prayer. They were finding it hard to have boundaries in the village, so we invited them to our house to stay over for a mini retreat. They came on Friday just before lunch on the bike they borrowed from her brother because theirs still has a tire that is bad. The husband had been sick the day before, and even though he felt a little better by the time they came, we still headed down to the clinic together after lunch. His blood test showed a pretty severe infection after all, so we had to put in an IV line which he kept for the next 245 hours so he could get IV antibiotics. But we still tried to put together a nice retreat for them. When they arrived we had a nice meal ready, mostly food we picked up from the store, because we had already established that I can’t cook a local chicken from scratch. Everyone slept in on Saturday, so much so that we didn’t have power for breakfast, which resulted in fruit parfaits and some bread with spread on it. Turns out the gas burner and a pot are not a good substitute for a toaster. But we went to the Wildlife Sanctuary after that, and they enjoyed seeing the crocodiles and looked into whether they could bring the children in the development center in the future. We went to a nice dinner, even though the crocodile fillets on the menu were out of stock, like usual.
Week 48: Prepare
“But Jesus called the children to him and said, “Let the little children come to me, and do not hinder them, for the kingdom of God belongs to such as these.” – Luke 18:19
In December, I am trying to focus on visualizing our future ministry and exploring potential areas to engage. Last week, we visited the Children’s Development Center that meets at Goshen Church of the Nazarene. Compared to 2 weeks ago when the church was filled with leaders of the local church and community, everyone dressed in a new matching chitenge pattern, this time the church at first seemed a bit more empty. But the hundred or so children sitting on the floor filled the new building with singing that was so bright and joyful it made up for the empty space. They sang “We welcome you” in English when we came in, and there was so much clapping and repeating of the phrase “Jesus for you and me.” Kids got up and did singing and dancing specials, and then stood in a row to recite memory verses – some knew as many as 5 that they recited in a row. When they were done, I stood up and recited the main Chichewa verse I knew, John 1:12. I wonder if I said it well enough that they understood the words. They next moved around and played games, and towards the end I was asked to join in a Red-Rover type tag game. I was glad that I had good shoes I could run in, I think I surprised the kids that I could run so fast, but boy was I tired at the end. Greg helped mark the kids hands as they came up for a cup of juice at the end. I was so inspired seeing Thokozani, the assistant pastor of Goshen helping to guide and mentor the children. I want to invest in this church and in the churches around and to come alongside Nixon and Thokozani with their ministry. I wonder what the future will hold in regards to that.
Week 43: Abide
“He has shown you, O mortal, what is good. And what does the Lord require of you? To act justly and to love mercy and to walk humbly with your God.” - Micah 6:8
I woke up early almost every day this week, but instead of trying to do a lot, I rested and read and just focused on being present. I am being greatly inspired by Mother Theresa, who embraced complete poverty and solidarity with the poor for the Glory of God. But Lewis inspires me too – he writes about the pleasures of life that are created by God and meant to be enjoyed without pretention or guilt. I love running as fast as I can with my dogs on either side. I love stepping out to the garden and seeing what is fresh – today I enjoyed making fresh herb butter, water infused with berries, mint, or basil, a strawberry spinach salad for Greg, Brussel sprout flatbread, chocolate covered strawberries, and vegan vegetable broth for future recipes. I also indulged in making dark chocolate thyme and chocolate chip cookies one night, which brought joy to Greg, Suzi, the Hirotos, and Sullie and Mart. And this morning I used up leftovers to make buttermilk banana pancakes and vanilla scones. I love creating things in the kitchen, and I love bringing fresh, warm food over to share.
All in all, this week I’ve really grown in terms of enjoying life and not just caring about achievements. I still did things, I still use my stopwatch when I run, and track my patients and hours each day, but I’m making progress little by little, I think. I even stepped up and taught devotions on Wednesday about what God was teaching me about resting and abiding in Him.
She looked tired, laying back on the bed with her eyes rolled back in pain. She came in with a headache, but as the night officer was observing her for a few hours, she started having seizures. She had 4 seizures between 6 am and 7 am. Praise God McClean was available to take over her care early. By 9 am Diane and I were reviewing the CT Scan, which showed a bright glowing of bleeding in the brain, clear as day even for two primary care doctors to see. We called Laiter to get the ambulance ready and Madalo prepared a nurse to take her to KCH where there were neurosurgeons. I was relieved that we provided her with care as quickly as possible. But later that day Madalo told me that she had another seizure on the way to the hospital and didn’t recover like before. She may never recover. She was brought in by two members of her family, with a report that she had been fighting with her husband and was hit on the head. They were encouraged to file a police report, but wanted to wait for the patient to file it herself, because her husband was on the police force and they feared retribution. What a tragic realization that she may never be the same again, may never even wake up. Did we do enough? Did we actually do anything for her?
Week 45: Engage
“Now the multitude of those who believed were of one heart and one soul; neither did anyone say that any of the things he possessed was his own, but they had all things in common.” – Acts 4:32
This week Greg and I watched a documentary called Godspeed. It was about a pastor from America who learned by working in a Scottish parish that Jesus’s example was about knowing and being known, and going through life at a walking pace so that you don’t miss the important things. It was funny that internet was so bad that the 30-minute film took us at least 90 minutes to go through, but it was a good chance to reflect with Greg about in what ways we could connect to others, and whether we were being called to set roots and remain in a certain community. Specifically they talked about learning names and developing roots. I’ve thought frequently about what we’ll do after this next year. It is terrifying to think about staying in Malawi without the buffer that ABC provides, but more and more I’m being challenged that we should step out of our comfort zone and really live among the people. Even ABC clinic is being challenged to do this with their new malaria screening initiative. Mother Theresa’s example shows how to pour out love for people even when it hurts or you are empty. Lewis talks about how this entire world is just a shade of the immensity and eternity that is heaven, and When Helping Hurts challenges me to think about how I can be improving my relationships with God, myself, others, and the environment.
Week 46: Give Thanks
“For whoever does the will of God is My brother and My sister and mother” Mark 3:35
Standing in the beautiful new Nazarene Church in Goshen during the opening ceremony, listening to the rain pouring on the tin roof and hearing the voices of the choir singing, I was overwhelmed by how heavenly this worship time was. Children’s choirs drumming their rhythm, women’s choirs dancing energetically with babies on their backs, a capella groups echoing throughout the building, it was all surreal. CS Lewis talks about how heaven is represented by music because that is sometimes the closest we get to euphoria on this earth. I think heaven is going to have some places of honor for African choirs. We sat toward the front, ahead of many esteemed chiefs, and just behind leaders in the church of the Nazarene, some coming from Kenya and others from Zambia and Mozambique. Every once in a while I remembered that Greg and I were the only people with white skin in the entire congregation, but more often I remembered the beautiful matching skirt and shirt the pastor’s wife, Thokozani made for me ang Greg. They were beautiful, and with them, we matched the chitengi dresses of the congregation in a way that none of the other visitors did.
Nixon and Thoko are an incredible couple of pastors who always seem ready to welcome guests and make foreigners feel at home. I don’t know how the two of them are pastoring five churches in the area, but the sermon today highlighted how they were willing to go into the village while all the other graduates wanted to stay in town. I’ve been thinking a lot lately about where we are going to live next year. ABC campus is so comfortable – I have my garden which is producing enough for pesto, herb bread, strawberry spinach salads and butter lettuce salads and mint and thyme cookies – more than I can keep up with. So many roses are blooming I am running out of jars to put them in. And the dogs got dirty in the rain today, but they are enjoyable and it’s so nice to have a yard for them and places to run. We love the generator and all the social events, but it’s easy to avoid getting plugged into the local community, hard to get out of our comfort zone. I have been challenged by how Mother Theresa lived among the people she was serving, and the book When Helping Hurts talked about a couple who lived in low-income housing for 2 years, growing with the community before they began any projects. People over projects, processes over products. I look back nostalgically to San Bernardino, and how we really had community with some amazing people there. I wonder if we will ever be able to have that here. God has always helped me with every seemingly daunting transition, and I know he will make things very clear with our next step, but as I’m challenged and contemplative, I can’t help but wonder what 2019 and beyond will look like.
Week 47: Pray
“Behold what manner of love the Father has bestowed on us, that we should be called children of God!” – 1 John 3:1a
This week I wanted to focus on growing in prayer. I was inspired by Mother Theresa and how she was inspired to share God with the souls in the darkness of the Calcutta slums simply by teaching them to pray the Rosary. Greg and I looked into the Rosary and other forms of structured prayer together, and we found our own ways of praying that used our old track stretch routines to remind us what to pray with next and to get our bodies involved with the process happening in our hearts so we wouldn’t get distracted. I continued that mostly this week, and it helped me stay focused on different portions of prayer, including honoring God, asking that His will and His kingdom come on this earth, thanking Him for His blessings, asking supplications, and confessing my sins. Confession is something that is a bit strange for me to dwell on as a Protestant who has walked with Christ since childhood, but I find that it is helping me take inventory of myself more and being more aware of His grace and the things I do that push Him away. Oh that I could be like Mother Theresa and truly not deny God anything, but share in his suffering and have a single minded passion to live among the poor and alleviate their suffering by sharing in the suffering of Jesus on the cross.