Weeping may endure for a night...

"Shallena, I had a dream. In my dream, we had lived in Malawi for ten months, and we were packing up to go home. I remember that I felt badly about not being able to work here, but not too bad because for some reason I knew we had to return and there was no other choice."

Jamie's dream was still whirling around in my mind when I saw Sharlene two days later and she told me that she had a dream about us. She said, "Shallena, I had a dream. In my dream Jamie and I were walking together and he was crying big, man tears. He said, 'I've given so much to this hospital and now I've lost Shallena.' But when we walked to your house, there you were making supper for your children." She sounded bewildered. I told her Jamie's dream. She gasped and asked, "Which night was that?" It was the same night.

Fast-forward about a month. We are at home in Loma Linda on our long-anticipated, joyful first annual leave. "It is so GOOD to be home," I exclaimed each day! Sunshine, perfect temperatures, no humidity--this is what Southern California is all about! Then Jamie walked in on me after I finished my shower.

Concern shadowed his face. "What's that?" he asked, looking at my breast.
"Oh, that's blood. It's been doing that a while."
He palpated my breast. Very clinical. His frown deepened. "You should see someone about that."

The next day we flew to Michigan and told Jamie's mom. She scheduled me a doctor's appointment for a week and half later, when we planned to return to Michigan. The following day we drove to Louisville for CME, and then to Gatlinburg to see my cousin and her family.

"I am telling you this because we have a family history," I began. Then I told her what was happening and concluded with, "I don't think this is cancer, because this hurts and cancer isn't supposed to hurt. It's probably a strange parasite I'm hosting."

My children and I drove to Michigan and Jamie flew to Utah for CME. The next day I saw the family physician. She examined, palpated, and wiped some slides with the fluid. "I think it's nothing, but I'm sending you for a mammogram." That was Wednesday. The mammogram was Thursday.

Later that Thursday afternoon, the radiologist talked to Jamie while he was in Utah. "It's diffuse and aggressive. I think a random biopsy would be diagnostic. It's cancer until proven otherwise." That night Jamie cried big, man tears. The next day, Friday, he changed his ticket and flew home. We cried incessantly that weekend. We couldn't sleep. I didn't know how long I would have with my beautiful, innocent, trusting children. I thought of their lives without Mommy, and my heart ached.  Our deep sadness made us very gentle and compassionate to others.

I squeezed Jamie's hand through the painful biopsy on Monday. We cried a lot. We saw the family doctor again on Thursday. Jamie held my hand as the physician said, "I'm sorry, there is bad news. You have cancer." She cried and prayed with us, and touched my heart with her sympathy. The diagnosis: "Breast Cancer, DCIS, Grade 3, 7cm, EP positive (20%), likely invasive." The date was November 20, 2013. The month until surgery hurt.

Surgery was scheduled for December 16. While waking from a drug-induced sleep, I heard someone say to me happily, "The lymph node was negative!" Good news!

The pathology report arrived at our temporary residence a few days later. "DCIS, grade 3, at least 4.5 cm, necrosis, noninvasive, 2mm clear margins, lymph node negative for cancer cells."

What can I say, except to quote the words of David, in Psalm 21?

             "The king shall have joy in Your strength, O Lord;
              And in Your salvation how greatly shall he rejoice!

2 You have given him his heart’s desire,
And have not withheld the request of his lips...

4 He asked life from You, and You gave it to him—
Length of days forever and ever.

5 His glory is great in Your salvation;...

6 For You have made him most blessed forever;
You have made him exceedingly glad with Your presence.

7 For the king trusts in the Lord,

And through the mercy of the Most High he shall not be moved.

13               Be exalted, O Lord, in Your own strength!
              We will sing and praise Your power.

I would also like to say that our church has only given us the love of God in this situation and has been thoroughly supportive, compassionate, encouraging, gracious, and kind. We are completely grateful!

We will be in the States until spring, or until my healing is complete, at which point we will be cleared to return to our mission post. Thank you for being our friends and for lifting us up in prayer. Please continue to pray for us, because the fear and emotional pain lingers along with the physical pain. But we know it will end! As a dear friend of the family said, "God knows your name. He hears it often." What an honor and an encouragement!

And, my friends, please remember "... BUT JOY COMES IN THE MORNING!"

Time

It's amazing how one year can affect a person so much.

Confused, we stared at the rear of the car. Which side has the steering wheel? As I drive I chant to myself: Drive on the right side, drive on the right side, drive on the right side...
And I can assure you, we had the cleanest windshield on the highway, because each time we needed to signal, those wipers came on instead!!

We stopped at the grocery store on the way home from the airport. After our purchase, I politely said, "Zikomo." The clerk looked at me strangely. Shaking my head and giving an awkward grin, I tried again. "Thank you!" She smiled, relieved.

After 42 hours, we arrived at our home! "Home! We're home!" I announced joyfully. My two year old daughter looked at me and angrily replied, "Dis not my home! My home Ma-wow-i!"

Driving in the car one day several weeks later, we heard from the backseat, "Daddy, where's my Mawowi?" And a few days after that, in a sweet, sleepy bedtime voice, "Daddy, I want to go back to Mawowi."

It's so cute to see her carry stuff on her head, but especially in the USA, where it looks completely foreign. Malawi is in her heart.

And it's in ours.

You see, we (especially I) complained a lot last year. It was a difficult adjustment for me. I was scared and angry that I lived in a place in which I felt alone and threatened so much of the time. Now that we know more about Malawi and we have enjoyed this refreshing time in the USA, we feel renewed energy to minister to the Malawians, through God's grace. I am so grateful that we are able to return home for a short time each year for that reason--and also because the children love to spend time with their grandparents!

Our time in the USA has been unexpectedly extended this year, and I wonder if perhaps God is giving us more time to reconnect with Him and His vision for Malawi. I pray we learn our lesson and that we are better equipped to serve others instead of ourselves.

Please pray for us! We appreciate your prayers more than I know how to express in words.

Busy kids

Some of you may wonder what the children do here. Get ready for some pictures!

They play with lambs...

work with Daddy on wood projects while chicks peck around...

play with their favorite toys...

hang from plumeria trees and hoot like monkeys with friends...

cage themselves in with the chicks...

play in a waterfall pool on Mt. Mulanje...

take wheelbarrow rides...

camp on the beach...

enjoy Lake Malawi...

make friends wherever they go...

try to throw stones from a hill into Lake Malawi...

live on the mini farm...

hold their pets in a big basket...

hold tiny miracle babies...

wheel 60 heads of lettuce in a wagon down to the hospital to give away...

watch monkeys in the tree right outside our hotel window at the lake...

play Peek-A-Boo in huge baskets that cost $4 each...

play in the sand pile with friends...

ride bikes at the landing strip...

harvest homemade charcoal...

and ride the plasma car (and scooters) through the house. Bye!

More Critters

You can't go to Africa and not post critter pictures!

This guy was right at the entrance to our driveway, about five or six inches long.
(About as long as my hand, anyway.)

This is a massive bee hive high up in a tree at the edge of the yard.

A hive infiltrating our house, between the roof and ceiling,
donated perhaps by the massive tree hive.

We now have a guest room full of bees! Be glad you're not visiting now!

Chameleon in our yard. The children had to touch him.

Chameleon at the lake. Ellie had to touch him!

On the hotel steps at the lake

New acquisitions--sheep! 

;

These are keeping us busy. Anybody want a cat??

Snippet of the Doctor's Day by His Wife

Some of you read our blog, desiring exciting missionary doctor stories like the kind that have been circulating the past few years on other missionary blogs. Let me tell you, I like them as much as anybody else. The unfortunate thing is that I do not often see the doctor, neither do his children, so why would you hear his stories? Let's see...

Right now it's 10:30 pm on Friday night and he's at the hospital trying to save a patient who is in diabetic ketoacidosis and is struggling for life. This is a common story for a medical doctor. We pray.
Update: While unconscious, she vomited a liter of blood, some of which she aspirated. There is still more in her belly. She's 35 and has 6 children. Only a miracle will save her life on this earth.

A few days ago a three year old patient was hospitalized after she bit her mother. The child had been bitten in the neck by a dog and became rabid. She died, and the doctors are quite concerned that the mother left without receiving treatment.

Currently there is a typhoid outbreak, and Jamie has several pediatric patients as a result.

What else?

For six weeks Jamie has been interim medical director. He's dealing with disgruntled employees, good employees leaving, administration, administrators who don't understand the medical part of the hospital, and working at understaffed clinics on his off days.

Okay, so I can't give the gorey and very interesting details because, as most of you know, I'm not a doctor. Hope this is a snapshot into his daily life.

On another note, the triplets are growing! Some of you donated money, and thanks to your generosity, these three are getting quite pudgy.

Here's a picture:

We thank God for their growth! It's a miracle to see all three living.

Learning to walk not by sight

"My tummy hurts, my tummy hurts." It seems she said it fifty times a day. Abigail didn't eat much and didn't play. Then she began vomiting. For three days she ate and drank nothing except water, which her body rejected. The next morning she awoke at 6:45--late--and fell asleep one hour later. I texted Jamie. "Bring her to the hospital now."
She was admitted, her blood sugar 37. We gave her ORS and antibiotics. She had cryptosporidium. For five weeks she was in pain.


Meanwhile, Jedidiah had a random high fever for one day.


A couple of days later, we went to the city. True to our experience here, as the day progressed, Abigail developed a fever of 103 F. (My children have started fevers on our day in town a few times.) We were at the art gallery eating lunch, and I decided to take her to the clinic where Jamie was working. She was breathing funny and I was worried because she had been sick so long.

When we arrived at the clinic, I looked for my Ergo, in which I keep my wallet and money, and it wasn't in the car! I looked for my phone, but it was gone, too! Oh no! I must have been so distracted that I left them on the table in the restaurant! I took Abigail's temperature, gave her some Tylenol, and drove back. The proprietor had rescued my Ergo, wallet and money included, but the phone was gone. Thanks to God for protecting the things we found! Phones are replaceable, but the money, wallet with credit cards and driver's license, and the Ergo! Those would be difficult to lose.


Then on the weekend two people had similar but different dreams about us. One was that we were packing up and going home after ten months here; the other was that my husband was worried for me.


A few days later Jamie was in town again, covering the same clinic. After work, he went to find a greenhouse that someone told him about. It was down a dirt driveway off a dirt road. He had asked me to find it one day with the children, but I was unable. When I saw that the children had fallen asleep in the car, I ceased my search.

Finding no one at the greenhouse, he was climbing back into the truck when a man slowly ambled up. Speaking in Chichewa, Jamie asked, "Do you work here?"
"Yes."
"Then can you answer a few questions for me?" He locked the truck and asked the man prices and names of various plants. The man didn't seem to know his plants very well.
Jamie began to get back in the truck. "Thank you for your time. I won't buy anything today."
"Bwana, can you tell me what time it is?" the man asked.
Jamie took out his phone and turned it to the man so he could see it as he said the time. The next thing he knew, the man grabbed his phone! "No way!" Jamie thought and held on fiercely. With his free hand the man grabbed Jamie's arm. Jamie returned the favor. There they were locked until the man said, "Bwana, there are no police here." "Oh, yeah, that's true!" Jamie thought and hollered, "Help!" The man ran away, losing a shoe as he ran. Jamie threw it in the truck.


Friday my head started hurting and it still hurts. It was the worst headache of my life. Jamie was worried -- hemorrhage, meningitis, malaria?  Head problems are hard or impossible to diagnose here because of the limitations of the mission field. It seems to be getting better right now, but there is still a lot of pain.


So why am I rambling about all this?

Some of you have seen our previous posts of some of the thievery that we have experienced here. Regularly I still find things that disappeared during the previous "era" of employees. (Weird stuff, such as taking the choke from our chipper/shredder machine. Why would they want that?) People who live here and who have visited as short term volunteers have stated that we seem to be under spiritual attack. Only God knows why. For a long time, as I struggled with fear, I tried to figure out if it is because we are meant to be here and somehow God will be glorified or if it's because we are just in the wrong place. Then one day I realized that it really doesn't matter. That's not my question to ask. If what we are going through drives us to our knees, converting our sin-filled hearts, causing our pride to fall in irrevocable surrender as we acknowledge our dependence upon Him, then may God be glorified. These present and passing troubles are nothing compared to being filled with the riches of Christ Jesus. Dear God, please forgive me for my ungrateful, complaining spirit. Please create in me a clean heart and renew a right spirit within Me...give me an undivided heart that I may fear Your Name.

Let This Not Drag On

What can I say?

This morning Kenneth the builder and his six men came to work on our yard. At 7:30 I received a call from a woman called Esitar. Not understanding anything, I hung up. The thought flicked through my mind that Kingsley, our former gardener/thief, was married to a woman with that name.

Later in the morning, who calls me but Kingsley! The connection was bad, so again I hung up. Why did I need to talk to him anyway?

Kenneth and his men overheard my conversation and he approached me. The men stood solemnly nearby. "Madam, I don't think you should let Kingsley come back to this house. He might bring black magic with him." I could tell they were serious.

Half an hour later, the triplets with their mom and grandma visited while returning from their two month check up. They are so precious and doing well, each one displaying his or her own personaliy. We got to hold them for the first time! Jedidiah held the tiny girl. Such innocence in one tiny bundle of chitenge fabric!

Our wonder was disturbed by someone approaching. Kingsley. Kenneth and his men stopped working to listen.

"You called my wife and told her that you wanted me here," he said.

"No, I didn't, Kingsley. She called me at 7:30 this morning." 

Coldly he replied, "Regarding what happened before, Madam, I forgive you."  

Steadily holding his gaze, I returned, "and I forgive you." 

He blinked, said the proper salutations, and left.

Kenneth and his men slowly resumed their work.

I thought about that exchange for a while, then went out to Kenneth and his men. I gave them a brief talk about our Creator God being much stronger than the devil, and that they don't need to be afraid while they are with God and while at our house. I don't know how Kenneth translated it all (one can never be too sure with him), but I hoped they heard something positive.

We ate lunch and put Abigail for a nap. After her nap, we wanted to go outside. But where were Abigail's shoes? She has three pairs of shoes--well, she had three pairs of shoes until Friday when we were gone to Satemwa Tea Estate for high tea. On Friday one of her Crocs disappeared, so now she has one pair of day shoes and one pair of church shoes that fit her. In the space of thirty minutes I turned this house upside down looking for them, including walking entirely around the outside of the house.

Back to Kenneth I went, determined that no one was leaving this house until those shoes were found.

"Kenneth, I need help. Abigail has three pairs of shoes. On Friday one of these disappeared," I held up a Croc, "and now the shoes that she was wearing today are gone. I need your guys to stop digging and look for those shoes now. I'll continue looking in the house." After some coaxing, they began searching. 

Back inside, I prayed. "Dear God, please be glorified in this. Didn't I just talk to them about trusting You? Please open my eyes to where Abigail's shoes are in the house, or else help those men to return her shoes. Please answer my prayer now, Lord, and let this not drag on. Thank You."

And guess what? Kenneth and three guys came around the house carrying Abi's shoes. He said that they were somewhere in the yard that she has not even played in today. My husband was frustrated, but I was glad. "God answered our prayer! We cannot make them stop stealing, but we have Abi's shoes back, and that's what we need. I'm grateful!" And truly, it did feel like success.

Thief

My body trembles, my heart pounds. Adrenaline still races through my body.

Tonight was a delightful Sabbath. Friends came over to play guitars, sing, and eat with us, and we enjoyed sweet fellowship. After dark we prayed together and went to our separate homes.

Then...well, wait. First I must tell you what happened yesterday.

Yesterday, I did something atypical. I reached out for support on FB and asked for prayer. Heaven heard about us yesterday and today in earnest.

Last night, I could not sleep. I cannot make it well past 9 p.m., but I was keyed up and didn't know why. After 11, I heard someone grab our doorknob and try to wrestle it open. The lights were on in the house and the curtains open. What if we hadn't locked it by that time?

Yesterday, the builder for our brick wall came to our house. At 2:45 he asked if he could help me in the house with a project while his men removed dirt where we need to build the wall. “Sure, Kenneth. Do you have time to fill the holes in the washroom? It opens to the outside.” He said that he had time to begin, pulled in an assistant and went to work. The concrete made a big mess, and he moved most of our stuff to the attached garage, which connects to the house through the washroom. When he was finished he pulled everything back into the washroom, except one thing. He left the bin of cat food in the garage, but I didn't know that...

until this morning. After church I went to feed the cat, and I couldn't find his food. “Oh, Kenneth must have moved it to the garage,” I thought, but then became distracted by something else before feeding Grady. I always feed him in the morning, but for some reason didn't today.

Tonight after everyone left, Jamie and I were getting ready for bed. He picked up Grady the cat and took him to the washroom where he sleeps. I told him that he needed to feed him. “Where's the food?” he asked. “It must be in the garage,” I replied.

Jamie went into the garage, using his phone torch. He usually walks in the dark but heard a sound. He quickly returned. “Call Marty right NOW!” he whisper-yelled. I tried to call Marty but couldn't get through, so I called Sharlene. She sent her husband with some big friends down, and by then I had reached Marty and he came with Alex. “Someone is breaking into our house. He's in our garage right now!”

Trembling with fear, I waited in the room with my sleeping children.

The guy hid behind some boxes, so no one saw him. Jamie said, “He's there! I was within one foot of him!” The men tackled him, laid him on the dirt and taped his legs together and his arms behind his back. The business manager and his guys took the thief to the police. He was wearing Jamie's old work jeans over his pants. It will be a bad night for him at the police station.

Now there are three guards with machetes patrolling my yard.

We have many unanswered questions about the thief, but also some others.

Why did Kenneth leave the cat food in the garage? Why didn't I feed Grady this morning? Why didn't Jamie turn on the overhead garage light as he often does? Why didn't the guy hit him when Jamie was right behind him? Why did it happen tonight when Ryan and Sharlene had several big man friends who speak the local language over?

I believe it's this: “And we know that in all things God works for the good of those who love him, who have been called according to his purpose.” Romans 8:28.

The Daze of Our Lives

It's 10:45 p.m. “Hey sweetie, a patient has a ruptured ectopic pregnancy and is in shock. I'm going to do surgery with Ryan. Don't wait up for me.” I won't, and I'm so glad we have a puppy.

Saturday morning we awoke to see an empty porch. What? Our porch furniture is all gone! And to add insult to injury, they took our perfectly ripe stalk of bananas! A rude awakening indeed.

Two weeks ago Jamie said, “Hmm, I thought we had $700 more than we have. Where did it go? Am I going crazy?” We calculated it and realized that the money was gone. We still had some doubts, though, which influenced what we did next.

We decided to go to the lake on Monday. Late Sunday night before we left, Jamie counted the money and wrote down the amount. We bid our gardener farewell Monday morning and told him that we would return Thursday. I saw a light turn on in his eyes. As we left we prayed that God would reveal to us if he was the thief.

The lake was windy and restful. It was so nice to get away. All was normal until four hours from home, Jamie saw some sheep. “I'm going to find the owner of those sheep!” We waited for one and a half hours, and finally a deal was reached. Our car was completely stuffed with stuff, besides two adults, two children, one dog, and now one ewe with two lambs. The sheep stunk! Every time the ewe needed to defecate, she kicked up a storm in the back floorboard under our son, who yelled, “It stinks! It stinks!” I remained speechless for a long time then looked at my smirking husband. I began to think that maybe he is going crazy. “This is not normal, you know,” I informed him. “You're going insane, and you're going make me insane. I need to take you home while there still may be a chance to rehab you to normalcy.” He said it was fun.

Immediately upon returning home, I put the children in a warm bath, unlocked the cabinet, retrieved the money bag, and sat on the toilet seat lid to count it.

“Jamie, didn't you say that one envelope had $2000 in it? I don't see anything like that here. Will you look at it? Maybe I missed something.”

“No, Shallena, it's gone. $1800 is missing.”

“Then it had to be the gardener. He is the only one with a key,” I responded.

We talked to the CEO of the hospital, who spoke sternly to the gardener the next morning. He completely denied anything.

Right after they left my house, Jamie called me. “I went to measure a patient. It took five minutes and when I returned, by computer was not in my office.” Are you kidding? This is unreal.

After talking with the police about the computer, they told him to return on Monday regarding our stolen money.

The next morning we were late for church, so I decided to drive down the hill. We ran around looking for the children's classes but couldn't find them. We hopped back in the car and began to drive. Suddenly the hazard lights began flashing and I heard a gurgling, boiling sound. The heat gauge started to rise. “Get out, Jedidiah! Hop out!” I slammed on the brakes, grabbed Abigail, opened the door for Jedidiah and habitually locked the truck. We ran into the hospital to find Jamie. While walking back to the truck, we heard the alarm blaring. Someone must have tried to open the door. Jamie drove it down the hill and back up and said it was fine. Okay, no it's not, but this all is starting to get to me.

That evening we took our little farm to the backyard: sheep, chicks, dog, cat, and people. It was cute. As sundown approached, we took the sheep to the front yard and put two big rocks on the rope tied around the ewe's neck. It took us about five minutes to round up the chicks in the backyard. Upon approaching the front yard with my box of chicks,--oh! Where are my sheep? This is unbelievable! “Our sheep are gone! Someone stole our sheep!” I shouted repeatedly. After about five more minutes, an American man and wife drive up. She was walking beside the truck leading our sheep. “They were about a kilometer down the road, but we heard that you bought sheep so figured they must be yours.” We thanked them and God, and I laughed about my overreaction.

They next morning, I stood on the doorstep with my little girl, when suddenly she started gagging and drooling. She looked at me with pain in her eyes and kept rubbing her tongue. I took her in the house and was going to give her charcoal because I thought she swallowed something. Watching her gag some more, it seemed better to not have her swallow anything and I flipped her over and pounded her back a couple of times. “Don't spank me,” she deplored. She obviously wasn't choking since she spoke to me, but her face was funny colored, she was in obvious pain and she was drooling a lot. So I did what any wife of a doctor would do, I raced to the hospital, horn blaring.

We jumped out—a little girl wearing an overfilled diaper and a shirt and me in my pjs and house slippers, little boy following behind. “What's wrong?” A lady at the steps asked. “I don't know!” I yelled. “Jamie, Jamie!” “He's in the main ward,” she said.

Jamie took Abigail to the OR and laid her on the exam table. Fearful tears ran down her little cheeks while Daddy and a medicial assistant looked in her mouth. Her tiny voice said, “My tongue hurts.” Suddenly I saw something small and orange in her fist. “What's in your hand?” I asked as I pried open her fingers. “Oh!!” we said in unison and laughed, relieved. She clutched tightly four spicy birds-eye peppers. We went home and gave her some ice.

That was yesterday, today is Monday. It's a strange feeling to have no employees working outside, but I really can't dwell on it. It's time to put out the sheep and feed the chicks.

Chicks!

We got chicks. The children love them. One night, Jamie got a great idea.

The dog was thrilled.

The cat was unimpressed.

They became comfortable.

 Aww, aren't they cute?

So we asked our gardener to make a chicken coup for us. He cut down a few stalks of our huge green bamboo, cut down some young trees, and gathered rope and grass.

"Rope", harvested from the Mombo tree.

He cut the bamboo into quarters and nailed them to a frame made of freshly cut young trees. The roof was last.

Tying the roof with the rope. Finished with two year old approval.

Making Charcoal

 I love to learn the way people do things here. Our guys wanted to make charcoal from one of the dead trees that they cut down. Here's the way it works:

First they dig a shallow hole and lay the sticks in it. The big ones go on the top.
An opening is left on one end to light the fire, and three openings are left on the other end.

Then they pile dirt and grass/weeds over the wood.

The fire is lit. An unpleasant smoke odor fills the air for one or two weeks.

Charcoal!

Little Boy Feet

It had been a fairly “normal” morning for me at the hospital, and I had even made it home by 12:30 for lunch. I started to eat while my little people and wife finished off another delicious creation. Jedidiah had woken up early that morning, and played hard. He likes to play hard here. He is always busy moving part of our yard to another part of our yard, playing with our new German Shepherd puppy, or making firewood. He finished and reluctantly went to his mandatory “quiet time”, and Abigail went for her nap.

After the daily protest the children quieted down, and I finished lunch. I enjoy eating, and I really seem to do a lot of it here. I find that eating has become one of my major coping skills. I have never had so much stress in my life, and eating is just such a simple way to unload a little bit of it. It doesn't hurt anybody's feelings, my wife makes great food, and I find a lot of my free time eating. I would like to think it is relaxing and enjoyable, but in reality, I still have that nervous butterfly-bubbling-stomach-electric-calf-muscle-feeling even when I am eating that yummy food.

I finally finished, and started with my back-to-work ritual. Gather my bag, don't forget the keys, go say goodbye to the children again....today it was really quiet in Jedidiah's room. He stopped taking naps a couple years ago, but every odd day quiet time gets the best of him. Sure enough, 55 lbs of all-boy energy and enthusiasm knocked out on the bed. They are so cute when they sleep. I kissed him through the mosquito net and rustled his hair as I said a silent prayer that God would save me from losing these precious moments with my children. Just before I left the room I saw them. I don't know why they stick in my mind so vividly, but they are always there – little boy feet.

Now, little boy feet come in very useful. I remember those same boy feet. At first it was the wonder of how they could look just like mine but be 50 x smaller. I was the designated tiny boy toenail cutter because mommy was worried about hurting them. Then as he grew it was This Little Piggy, and Happy Patty Cake Feet in the air. One time mommy bought these bright red socks, and we still laugh about how they energized those feet that they danced and jumped up and down the house every time they turned red. I love that boy, and I love his little boy feet.

Today the red socks have been replaced by a chalky orange. This orange comes from Malawi clay, and Jedidiah's feet are rarely found without it. These days, his little boy feet are busy getting orange. I smiled and reminisced for another moment, then started back to work.

There is a struggle I have, and it happens at least twice a day. I move in and out of two different worlds. One world is familiar and comfortable – we speak English and discuss familiar matters. We understand each other with saying very little to nothing at all, and we are usually healthy and safe. The other world is the hospital. Here the security is stripped away, and the thin line between life and death—that line that I once thought was very big and long and heavy--reminds me that I and my family, and my endless stream of patients are merely mortal. Here in Malawi it is a very thin line.

As I re-enter the hospital world, I remember the events of the “normal” morning. There had been a 2 year old boy who was in a bad kind of way. He had come into the hospital with a high fever, seizures, and anemia, and was at the time of my morning review comatose. He had Cerebral Malaria – the most deadly complication from Malaria which kills 25% of those who suffer from it. The current thought is that death from Cerebral Malaria results from diffuse swelling in the brain and brainstem herniation, even though this disease is still poorly understood. Earlier that morning, the child had classic findings of Cerebral Malaria, but was also breathing fast with a fast heart rate. We decided to do a lumbar pucture to make sure we didn't miss treating him for meningitis, and started some IV fluids and antibiotics in addition to the quinine he was already getting. It wasn't meningitis, but at least we knew.

Unfortunately, this little guy hadn't improved at all from the morning. One glance at him now showed his little body was wearing out. I looked at his beautiful poor Malawian village family – Mother, Grandmother, and an Aunt all sitting dutifully, wrapped up in their best dirty clothes, expectantly by his side. Looking at me feeling very confident he would get better since an “Azungu” was taking care of him. His oxygen level was low, and his lungs were filling up with fluid. I gave the family a knowing look and tried to give an appropriate embrace as I knew that the wailing would start within the next half hour. All of this is unfortunately fairly routine. I was turning to leave the room and write a short terminal note in the chart when I saw them. There they were. I tried not to look, but it was too late: the little boy feet. Those chalky orange little boy feet. Surely a few days ago they had been running in the Malawian clay; they too succombed to naps at quiet time, and looked preciously cute when they were asleep. But today they have run for the last time, they are about to cross that fine line.

Of necessity, I stiffle the emotion somewhere inside, and move on to see the other baby in the room who is also dying of meningitis. The “normal” day continues with just a few flashbacks of little boy feet. The wailing starts from the pediatric ward, and I take a deep breath. I feel hungry, but I know food won't fix it, how can someone cope with losing little boy feet?

Apparently all of the food hasn't been doing its job, as I can't write this story without tears.

“He will wipe away every tear from their eyes.” Revelation 21:4.

One day soon the thin line will be destroyed, and the little boy feet of the world will run in the chalky orange clay of heaven, and I will be eating heavenly food with Jesus without that nervous butterfly-bubbling-stomach-electric-calf-muscle-feeling. I can't wait.

--jamie

Grandma's Adventure

Jamie’s mom visited and took us on vacation. We stayed in the Sunbird Nkopola lodge at Lake Malawi, located just past Mangochi.  While there we took a one hour speedboat ride to small Bird Island. We fed the fish eagles and snorkeled with cichlids. On the opposite side of the island we viewed cormorants and five foot long monitor lizards sunning themselves on rocks. It was fun to feel the wind and the sun, and I wondered why I have not boated much in my life.

Fish Eagle

Cichlids

However, that was not enough “adventure” for Grandma.

The next day we drove up to Cape Maclear. She wanted to eat at a place called Danforth Yachting. Upon arrival we encountered a locked gate with a call button. Pressing the button and stating our intention, we were greeted with a stiff British voice stating that the restaurant was for paying hotel guests only. Grandma didn’t really seem to like the sound of that, and she is always ready to try something new. This was the perfect setup for what happened next.

Driving from there we passed the entrance of a national park. About five men were standing there who seemed to be doing nothing. As we slowed around the turn, they ran up to the truck. It went something like this.

“We can give you a really good deal!” they shouted.

“What’s that?” Grandma asked. Oh brother, I thought.

“When you enter the national park, we can give you a very nice tour of the lake. You can feed fish eagles and swim with the cichlids. We’ll take you to a natural aquarium.”

“We did that yesterday,” Jamie said.

“But our tour is very good. We are tour guides from an association. He’s the president, he’s the treasurer, and he’s the former president.”

“We don’t want to pay the national park fees,” Jamie argued.

“No problem. We’ve got a boat near Danforth Yachting, ready to go. No fees there. There’s a place to park your car.”

“At Mgoza lodge today they told us that if we wanted a tour, they could call some tour guides for us…” Jamie began.

“IT IS US!” A jubilant proclamation! Grandma’s eyes were dancing. I could tell where this was headed.

“It’s 12:30, the children are hungry.” I attempted to be a voice of reason.

“Don’t worry about that. Don’t worry for anything. We’ll cook some food for you. We’ll have it done by 2:00. We are PROFESSIONALS!!”

“It will be four,” I muttered.

And that’s how we found ourselves driving behind some guys who were running down a dirt road leading us to their parking lot. Dan announced himself as captain and promptly disappeared. We saw him only upon return.

And how we boarded the stalling Nety and sailed for Diamond Dust Beach, which was really a very dirty looking tiny beach on an island that had a black section of sand. It appeared to me to be charcoal from their cooking fires. They, however, assured me that it was diamond dust.

The Tour Guides and their vessel

Natural Aquarium was really a tiny rocky stop on the island. Bird poop covered everything. An old German guy in speedos arrived shortly after us, and sat on the only other rock directly below ours chain-smoking. I took the children to sit on a rock at the water’s edge. Grandma went to talk to the old guy. The cichlids were beautiful.

And that is also how we found our vegetarian selves in the Nety anchored at dirty Diamond Dust Beach, devouring nsima and vegetables made with the biggest packet of beef flavoring that I have ever seen, with our hands on dishes borrowed from naked boys swimming nearby. At four o’clock.

Our cook

“That was so fun!” Grandma said as we left. After she returned to the states she emailed, “That was so much fun, but it probably wasn’t the wisest decision. Don’t take any more African adventures like that. At least not without me!”

Monitor Lizard

--shallena

Unqualified!

Most days practicing medicine in Malawi I feel like I don’t know very much.  I am trained in Family and Preventive Medicine – they are specialties, but very broad.  I was trained mostly in outpatient medicine, but work mostly in the hospital.  I was trained to use an advanced set of diagnostic services, and here there are few.  Put into a tropical context the depth of understanding and experience I have regarding what I do on a daily basis is quite limited, and I feel incompetent every day.

A few nights ago I was called around midnight by the clinical officer, “Doctor, I think there might be two babies, will you come and do an ultrasound?”  As a diagnostic tool ultrasound is very practical here.  We have a small portable unit, and it is invaluable – if you know how to use it.  I had very limited training in residency with ultrasound – I could measure the fluid around a baby, tell if its heart was beating, and whether its head was down or not.  I could also probably tell whether somebody had a liver or not…

It seems like it should be pretty easy to tell whether there is one or two babies in a women’s belly.  I always pictured it as a black and white matter, but at 1:00 am this morning it didn’t seem so easy to me.  I looked around in the very round abdomen (which was definitely larger than the 33 week gestational age reported by mom) for about 30 minutes, and was pretty sure that I saw one head down, and one head up.  I was also pretty sure that I saw two different hearts with different heart beats.  It had taken a while, but I felt pretty sure of my diagnosis – “Twins!” 

Now if that were the end it would be a nice story, but there were a couple other questions: the patient had a gush of fluid 6 hours ago, and the midwife had felt a pulsating cord next to the presenting part when she did a vaginal exam.  I checked the cervix myself – it was 3 cm dilated, the head was not engaged, and I did feel a pulsation on the left side deeper in the pelvis.  Now, at this point I should put a bit of a disclaimer here – I am a Family Physician – not an obstetrician.  I have never delivered twins, seen a cord prolapse, and have always transferred patients with preterm rupture of membranes to the nearest obstetrician on call.  So there was a bit of perplexity that found its way into my diagnostic algorithm because tonight I was THE doctor on call. 

After a little discussion with the clinical team and patient we decided that we should pray and give her some steroids (to help the baby’s lungs mature), antibiotics(to prevent an infection since her membranes had ruptured), and salbutamol (to try to slow down her contractions). 

I headed back up the hill to get a little sleep.  About an hour and a half later my phone rang again, “Dr, the cord has prolapsed. See you in the Theatre (OR)”.   I was afraid that would happen.  I hurried back down the hill.  When I entered the Operating Theatre, sure enough there was the umbilical cord.  It had a strong rapid pulse.  I had once read a story about a missionary doctor who had held a baby’s head off of a prolapsed umbilical cord for several hours while they drove to a surgical facility.  It made sense to me, so I put on some gloves and pushed the baby up off the prolapsed cord while the clinical officer prepared to do a caesarian section.  The anesthetist placed the spinal anesthesia, and the surgery commenced.  I was impressed with the surgical skills of the clinical officer.  I thought about his training – he has three years of training after high school, but he handles any emergency in the hospital whether pediatric, adult, obstetric, or trauma.  The Malawi health system depends on clinical officers – they are the clinician of Malawi, and at least ours do a great job for the training they have had. 

He finally opened the uterus.  I had been pushing the baby up for about 30 minutes, and the pulse was unreliably present by this time.  With a little trouble he extracted the first baby which was the one I was pushing on.  The baby was clearly asphyxiated – blue, breathless, floppy, but had a heartbeat.  We took Baby 1 over to the resuscitation table where we dried and stimulated the baby, but with no response.  We started to bag the baby with oxygen.  The color was starting to improve when the nurse brought another little blue baby and set it down.  Baby 2 was also floppy, but was at least breathing intermittently.  We started to do a bit of a unique resuscitation – two babies, one bag mask – hyperventilate a little here, then there, dry, stimulate, suction, etc.  I was feeling pretty bad right about now, as it looked like both babies were in a bad way.  I was working on the babies with the anesthetist when he said, “Go get the other one”.  Other one?  

Then the nurse handed me a tiny Baby 3.  This one was almost half the size of the others, but she was breathing, had good color, and normal tone.  She joined her two brothers on the table, and we just settled in for a cozy resuscitation.  After about twenty minutes Baby 1 started to breathe on his own – thank goodness!  Baby 2 by this time was pink and moving, but still with rapid shallow breathing.  Baby 3 was just chilling – eyes open taking in the newness of life, looking for her first meal. A few minutes later Baby 1 started to holler, and didn’t stop until I left.

Baby 1: 1.6 kg  (3 lbs 8 oz)

Baby 2: 1.5 kg  (3 lbs 5 oz)

Baby 3, Girl, with Grandma

Baby 3: 950 gm (2 lbs 1 oz)

I looked at the three babies with their hand-knit hats bundled up in their sheets, and I was grateful.  I was the least qualified to help them come into the world, but here they were.  In Malawi, 25% of children die by the age of five.  Unfortunately, these three have a much steeper mountain to climb.  They are small, premature, and had a bumpy start, but at least today they are alive.

“The Lord has done this and it is marvelous in our eyes.” Psalm 118:23.  Despite my limitations, God made something beautiful.

In medicine it is easy to feel that our success is dependent on our experience, knowledge,  and qualifications.  If you are getting  bogged down in that kind of thinking, come visit us in Malawi where there is a different kind of medicine – the kind where God doesn’t depend on our qualifications.  We need a qualified obstetrician.

--jamie