December 30th 2014 
I am sitting in an air-conditioned room (the first one I
have been in since arriving in Malawi) having just spent a few hours playing in
lake Malawi. We have cold water to
drink, warm water to swim in, plentiful food in buffet style,
comfortable beds and guaranteed electricity. For the past 3 days we have been
far away from any discomforts. We had
been anticipating this vacation for a few months. The boys are on their 3rd
of 4 weeks off for the Christmas break and have been eager to be on break as a
family. I feel like I have been going
pretty hard for several months putting my work goals ahead of our family. I was looking forward to switching gears to
truly cherish them and time together.
We decided on a Safari and some time at the lake. Bill and I
have a hard time with planning vacations and this came together only at the
last minute. In thinking about where to
go, I think we feel paralyzed by the number of good options. We wanted to make our time “count.” It was not really the struggle of choosing
from any number of desirable destinations (one should not really feel too sorry
for this hardship) it was that a vacation for us means leaving Dr Emmy Davison
(the current resident here with us) by herself in Blantyre. I agonized about whether this was the right
decision—will she be adequately supported, safe, orientated? Will she have a good enough time in Blantyre when she is not working.
Will she be overwhelmed, sad, frustrated and without someone to talk
to? Whenever I put my 30 y.o. resident
self into her shoes I concluded that I would not want to be “left alone.” But Emmy is tougher than I would have been
and she assured me that she would be fine.
She is resilient, positive, and ready for any challenge. She took call
on Christmas Eve and has run the busiest clinics we have had so far. And—because of holiday vacations—there have
been the fewest number of clinicians around to support her. Not only to I have great admiration for her, but
also I appreciate the gift her attitude to send us away with her blessing.
Three days ago, we drove from Blantyre to Mvuu Camp at Lewende
national park to experience the bird and wild life of Malawi.
Mvuu Camp sits on the banks of the Shire River
where crocodile and hippo are more plentiful than logs or rocks.
After recently watching
the Big Year (a movie worth a watch!) it was difficult not to
eagerly tick off rare birds as we spotted them, though we saw only a fraction
of the more than 350 species of birds that live there. Liam and Micah were won
over by the African Kingfisher as they hover like hummingbirds before diving
into the river to capture small fish.
I
am still in complete awe of the elephant.
Their social behaviors, migratory patterns, role in their ecosystem,
species survival are qualities all fascinating to learn about. Their long
eyelashes, attention to their young, playful behavior, and grand silent steps
are breathtaking to watch.
Their instinctual
behaviors to protect themselves and their young from humans warrant much
respect.
So when two babes with their
mom are less than 10 feet away from your window at 1 am, this is a pretty
effective adrenaline rush.
Pictures are
better than words to capture the wonderful experience there.
Our boys had a blissful time as did we.
Our home for a few days in the African bush, neighbors to Elephants
After two nights we drove north to Senga Bay
and are staying in one of the oldest hotels in Malawi. It was built in the
1930s and is absolutely perfect.
Last night Liam checked in with us about our financial
status, this is not unusual for our slightly anxious, responsible son. “You guys are spending too much money! Are we going to run out of money?” Though I can’t help but quickly reassure him
that we are okay and we are not going to run out of money, I deeply appreciate
his questioning. I think this reflects a
number of things going on in his quickly developing brain. First, we pay cash for everything here. Imagine, for a moment, going on a vacation
without using your credit or debit card.
The only way for us to transfer money from our bank account to the hands
of the beneficiary is to withdraw cash from an ATM in qualities limited to
80,000MWK per day (80,000MWK = 80 x 1000MKW bills = ~$160), stock it up and
then bring it with us to our destination whether a shop or a luxury hotel. The stacks of money reach sizable heights and
it is very clear that this x, y, or z item has a cost that is different than when
you hand a credit card to the cashier. Second,
the consequences of poverty are part of our moment-to-moment reality. Living without a car, eating Nsima everyday,
carrying the water you need on your head is the reality of our neighbors. To a child, the disparity makes even less
sense to them than it does to us. What
makes us different from these Malawian neighbors is not a profound question to
them (it only becomes profound as we have more life experience.) If these neighbors had a stack of money--only
one inch high--their lives would be so much better. And we are spending inches of money right
before their eyes. Third on a daily
basis, we are careful with the money that we spend. Buying a superfluous item is an acknowledged treat,
we did not have many Christmas presents this year, and Bill is known to work
hard for a bargain in the market. The
juxtaposition between our daily reality of frugality with that of this vacation
is incongruous. Liam’s second question
“Are you guys going to run out of money” is a question that has a mathematical
probability associated with it. I can
answer that it is unlikely that we would run out of money because we have saved
and budgeted for this time. However, his
first statement --“You guys are spending too much money!” is much harder for me
to respond to.
I have been thinking a lot about the concept of
sustainability.
I believe in the work that I am doing here. I believe in
training African Family Physicians to work within the communities to deliver
first contact care within those communities.
I believe in helping to develop Ndirande Community hospital into a pilot
that functions in this way so that other community hospitals have a model to emulate. There are so many needs, there are ways that
I can contribute and there are ways that I cannot. But what is constantly on my mind is how can
I contribute in a way that promotes an outcome that is sustainable. I am reading a book now called “The Challenge
for Africa” by Wangari Maathi who won the Nobel Peace Prize with her work in
Kenya called the Green Belt movement.
She describes the current reality in African development; the progress
is inseparable from the damage done by colonial rule. African progress is both dependent on and
stagnated by foreign aid. She advocates
not for cessation of aid but well appropriated aid, aid that empowers local
leadership in their efforts to address critical problems facing Africa. Every day I think about these principles and
whether or not our efforts are contributing to or detracting from forward
progress. Coming with SEED Global
Heath—a well connected and informed organization--makes me feel confident that
contributing to teaching and propagating of a robust health system is grounded
in principles of forward progress. It is
the days when I am buying candles and flashlights so the nurses have light by
which to deliver babies when the power goes out at night, or when I am fixing
locks so that clinicians feel safe on call at night, or when I myself am seeing
a long line of patients and treating them with my western trained medical
knowledge which might not be appropriate that I question whether I am
contributing to or detracting from progress.
Using my money to make these changes is not sustainable. Just as Liam would state with some concern,
“You are spending too much money” I wonder if I am inappropriately spending my
money and the money of those who are generous to help.
But as is the case with this vacation, it is not sustainable
to be living like this forever. This vacation is doing more for us than
providing us with luxury for a few days.
We are also buying memories, rest and rejuvenation, time together as a
family and perspective on why we are here.
I hope we are buying a fresh start to the New Year, energy to poor into
the challenges that inevitably lay ahead.
I want to think of the money that we are spending and raising for
Ndirande in a similar light. We cannot
fund this health center forever. But we
can buy some momentum to get it running well, to show what it has to
offer. We are investing in the vision
that is being promoted by Dr Makwero and other Malawian leaders.
When they are swimming in the lake, playing with a new toy or watching a kingfisher
dive into the Shire river I see the boy’s spirits come alive.
I believe this is healthy for their
development as exceptional humans.
And
when, at Ndirande, the nurses feel that someone cares about them or when the
work environment becomes more conducive to the good work that is being done, I see
their spirits come alive. I believe this is important for the development of
this program.
Happy New Year to all. May you find ways to help your spirit
come alive.
Bill dancing with one of the Health Surveillance Assistants at boxing day Ndirande party
... because I could not resist!
On the way home, one of the chickens laid our first egg. We gave it to Brenda, our day guard, so that she could add it to her lunch. Apparently, these hens can lay 300 eggs in a year. With 8 hens, I think we'll have plenty of eggs coming our way!
