June 8th
I turned 41 last week.
Based on the suggestion of Dr. Mo one of our recent visitors, I was
challenged to make a list of 41 goals for the coming year, a “41 at 41
list.” One of the things on that list is
to write more thank you notes. In other
words I want to be a person who expresses gratitude. Three days ago I experienced gratitude that
has put “writing thank you notes” into perspective: aa grain of sand is to the
sand on a vast beach, a thank you note is to this experience.
Friday
was my final day at Ndirande health center.
Friday started as a normal day. I arrived at 8am, went to the “handover
meeting” where the maternity and medical cases are presented by the labor nurse
and the post-call clinician. Dr M,
myself and Dr Z offer some teaching relevant to the presented patients and
announcements are offered. That morning
I was told to be ready for something at 2pm. I proceeded with my morning: rounding on
antepartum and the short stay ward, and then I started seeing the patients who
line up daily in the “queue” to be seen by the “consultant.” Seeing patients in the queue usually lasts
the better part of the morning (until about 1:30) and then we break for lunch
and complete the day with more outpatients, emergency cases, procedures, or OB
consults. I know this routine well. My interpreter and I have a comfortable and
efficient rhythm. The patient’s common
problems, routine procedures and even many of the individual patients are
familiar to me now. I know our room,
the smells, the dust and the broken faucet.
I know the limitations of working in this environment and how to
navigate to try to provide the best care for the patients who come. The other clinicians and nurses are comfortable
with asking me for help or advise and even pointing out things that I did not do
correctly. I am comfortable interacting
with them as colleagues and friends.
There are people whom I greet every day and am given a big smile in
return and there are the daily predictable stares by people who are silently
acknowledging that it is strange to see an Uzungu (white person) around
Ndirande. I am used to this place.
As 1:30 approached and the
queue was coming to an end I starting taking pictures of seemingly mundane
things that would allow me to keep the memories of this feeling alive after I
return home.
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| sign for the consultant clinic on the door |
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| the sink and window in our consultant room. |
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| one of the two examining tables and our ultrasound machine |
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| looking out our door at the health center |
Working together with me
this day, Dr M would periodically express sentiments of sadness about me
leaving which I tried to ignore for fear of tears erupting. I feel like it has been a gift to me to work
here. As I anticipated coming to Malawi I had wishes. (I will not call them goals as that sounds
too practical and serious.) These wishes
were the things that I would think about in my daydreams.
* I hoped for the residents that they would find joy using all
the skills they have learned in residency to take care of patients no mater
age, condition or circumstance. I hoped
that they would feel part of a team that was vastly different from the team
with whom they work in Seattle; I wanted them to gain both a sense of
confidence that they can adapt to a different setting and contribute to the
vast needs that exist here but also experience humility realizing how much they
can learn from those around them.
* I hoped for myself that I would be a model of patient
centeredness and principles of family medicine.
In a country that does not know this approach to patient care, I wanted
to do my part in a small corner to demonstrate what this can do. I wanted to lose some of my fear that I
“can’t do it, I do not know, I am not capable, some is better than I am .” I wanted to become more of an African
doctor—just do it because it needs to be done.
* I hoped that I would be able to look back and say, that place
functions better, the Malawian clinicians have higher job satisfaction and
those patients receive better care because we were there.
Friday afternoon was a
daydream coming to life. At 3pm I was invited around the broken gate to the
houses behind Ndirande. Chairs, a sound
system and a barbecue were being set up.
Crates of sodas were being carried to the scene. Slowly my colleagues were arriving in
beautiful clothing (different from the uniforms they had worn in the morning),
chitenji wraps, decorative headpieces carrying bags of food and gifts. When
the smoke from the barbecue filled the air and the music was bumping the
festivities commenced. “The order of
events today will be opening prayer, speeches, food, dancing and closing
remarks” announced Dr Z in a perfectly balanced combination of honor and
friendliness. I wished that I could have
captured the things that my colleagues and friends said that day. Not only were they generous with their words
toward my efforts of working in Ndirande and contributing funds to help support
changes in the physical structure, but also they spoke of improved teamwork and
collegiality and a sense of their work being purposeful. The words were illustrated in the scene
around me. We had a gathering post
Christmas, a time for people to gather and share food. It was a nice time. But this was so different. There were three times as many people and
three times as much a much laughter compared to the December party. Everyone was dancing and I could tell it was
because their souls was joyous. I saw clinicians and nurses hugging (not something that would have happened readily
5 months ago) and they wanted their
picture taken together.
In a setting
where people think twice about buying a hot lunch for one dollar, people were
feasting on meat, samosas, fried banana bread, potatoes and salad. Drinking of
Fantas, wine and beer was plentiful. Smiles
punctuated with laughter went on for hours .
Mr Phiri—clinician lead, a man who has started and ended this year with
me, taken the residents on dermatology outreach trips and shared call with
them--gave the closing remarks. The rate
of his speech was turned down a notch reflecting the influence of 3 hours of
wine drinking but his smile was as exuberant as ever. He spoke about the significance of the year
by acknowledging each resident by name.
“First there was Ben and Beth. The first ones, they worked hard, they
were so friendly and funning. I heard
that Ben donated some money after he left. Then there was Kannie who loved
everyone, she was one of my favorites.
And then Emmy and Emily and Laura…”
He kept going on and on with each resident, in order, without notes, acknowledging
their personalities. “And Janelle, she
spoke Chechewa and she will be back… and then there was the BIG THREE….”
(Referring to Dan, Nick and Rebecca.)
This speech took a significant amount of time such that people were
tapping their wrists playfully reminding him
that the sun was setting as he was giving his closing remarks.
I was given beautiful chitenjes to wear, a dress made for me by
a certain tailor who had my measurements and matching shirts for my family, a
large cake, and a bottle of non-alcoholic champagne to pop ceremoniously. The residents left behind six white coats and
I was able to give six white coats to the six clinicians who have been with us
on this journey as well as some laminated photos that I had taken throughout
the year.
This party was so much
beyond what I deserve and it represents financial sacrifice that is
incomprehensible to me. But it was one
of the best days of my time in Malawi. I
am so deeply grateful. I am not sure
that writing a thank you note will be sufficient for this. But I will do it anyway since it on my 41 and
41 list.
We are traveling home in
less than two weeks. The tension between
coming home and the desire to stay here in this life is like a taught guitar
string. It is a good place to be. I suppose with this analogy we can imagine
that this is the music of a rich life.
