I sat in the cold, empty room. We used to meet here most days for hospital handover before we decided that it was risky to have every hospital nurse and clinician together to discuss cases during this time of rapidly-spreading virus. I spaced the chairs out so that 15 people could sit where sixty used to cram. The training was supposed to start 90 minutes ago, but so far, I was still the only one here. A lab technician dropped in about an hour ago, but since the government Environmental Health team hadn’t arrived and he hadn’t eaten, I sent him over to teatime at the Medical Ward, where I still send donuts to encourage them once a week even though I don’t work clinically on that ward anymore. I used my time to organize a list of all the teaching meetings I have attended since I arrived ten months ago. That should help us as we attempt to renew our licenses later in the month. A clinician arrives and we talk about his experiences working at the hospital over the last thirteen years. He gives me some pointers on how to avoid the mistakes made by missionaries from the last generation. He also tells me that the first day of a training session in Malawi always starts late. Everyone expects it to take time for things to get set up. He assures me that when the training team arrives, this empty room will suddenly fill.
And he’s absolutely right. Though the training team arrives two hours late, within minutes of their arrival and turning on the projector, every seat is taken with a selection of our nurses, clinicians, and health surveillance assistants. I wonder how the word spread that now it was time, how the group was able to come all together. It makes me remember how most sustainable movements happens in Africa within community. As a foreigner, I may never understand the channels of communication and networking and when to know when everyone is ready, but if I patiently wait, the impact will be bigger if we all go together when everyone is ready. It’s a great training, planning how we can reach into the community to track cases and contacts and contain this spreading virus. Everyone asks questions and plans for contingencies. It’s great to see the HSAs and nurses and clinicians so interested in this together.
The second day of the training begins just over an hour late. I still arrive on time, to be ready for anything, but I’m neither surprised or disappointed. I’m prepared to use my time well, and I brought a heavier jacket today so I won’t get so cold. This time, I read through an online journal article about physician resilience and preventing burn-out. Then a nurse arrives and we chat for some time about our families and fitting in with the community. Again, within minutes of the team arriving, every seat is full and we have another productive day of teaching. When the training is over, the team asks if we are ready to put together a list of names for a rapid-response team providing 24-7 coverage for rumors and issues in surrounding villages. But I’ve learned. I need a meeting with the heads of departments, with the co-chair of the COVID preparedness committee, and with management before we can even think about moving forward. We contact the ministry of health to clarify issues, we pilot an outreach with our Environmental Health officer along with the district team, and we sort out reimbursement issues. We may or may not be ready in time for the surge that is likely coming, but I am confident that the team will rally eventually. By the end of the week, I’m not sure how much I’ve achieved. More than half the meetings I planned were cancelled, but then there were half a dozen unexpected meetings that moved other things forward. I have to be willing to see what happens next. There’s a proverb in Africa, “If you want to go quickly, go alone. If you want to go far, go together.” It may be ironic to follow that proverb while trying to put together a “rapid response” team, but I don’t think we could make an impact any other way.