"Pang'ano, Pang'ano"

Pang'ano, Pang'ano is "Slowly, Slowly" in Chichewa. I recently added this word to the chichewa dictionary in my head. I think it fits the Malawian culture and approach to things perfectly. There is almost never any urgency or emergency in life here. I have seen people hurry occasionally but even in a big hospital like Malamulo we don't have an Emergency room!! It is the same with the business side of things - when I think of whether we are making progress or not "slowly, slowly" seems to fit. There are a few glimmers of hope -

Last week we made arrangements with the only pathologist in all of Malawi (who has an office in Blantyre) to send him specimans from the hospital for a flat fee (approx. $35 USD) since the patients are so poor. This rate is still out of reach for some but encouraging at least to have the option for patients.

We also arranged with a pharmacy supplier to provide drugs that are needed at the clinic in Blantyre. We struggle to keep the stock they need there and since this provider is located a few blocks away it will make the service much better. This will also be helped by the loan of 1 million Kwacha (~$6,600 USD) to give us a basis for purchasing the items. The income from the sales will go back into that account and [hopefully] continue to fund the supplies for the clinic.

The challenges come when the guys from the pharmacy supplier don't follow through when they say they will and we have issues setting up the bank account to keep this loan and "jump start" money for the clinic.

I am happy to report that we purchased 30 brand new mattresses for some beds in pediatrics with some money that my friend Melissa donated. Those arrived a couple of weeks ago and just today when I wandered through they are starting to be used! Also we got 7 exam tables donated by World Vision and are getting 52 new hospital beds with mattresses donated from ADRA!! We also have another container that has arrived in Blantyre from the organization "Giving Children Hope" (www.gchope.org) that should be here this week.

All of these things add up to be really positive for the hospital... and I try to keep that in perspective but it is easy to get bogged down in the details and the incompetence of individual people. There have been days this week when I've had to be firm and direct with people to be sure that the importance of the issues is communicated. This goes back to the first comment that there is no urgency about anything!!! Daily reports, assignments to be done, patient bills and accounts done correctly (all manual) - nothing seems important or serious!! To my western mind this is completely frustrating, as you can imagine! **deep breath**

It is CRAZY hot today so I think Cristy and I are going to head home early. Going home and being comatose and a glass of lemonade sounds very appealing!! Until later ---

A Wedding

The longer I wait between writings the more there is to say – I apologize in advance for my long-windedness.

Wedding Bells!

To add to my cultural immersion of late, I attended a Malawian wedding the other Sunday The ceremony itself was nice – held in the Malamulo church with many attendants (lots of children) who marched/sached/danced down the aisle. There was a choir that sang a couple of special wedding numbers, a unity candle, the flowers were artificial but the bride was beautiful. There was a hug after pronouncing them husband and wife. A kiss would have been way too much “PDA”. The reception was held about 2 hours later (after everyone went home for lunch). The DJ played music from huge speakers with the MC calling various people up for pictures with the couple or to give gifts. While up front they had to dance to the music while tossing money into baskets held by the bride and groom. Explaining it in words doesn’t do it justice and I’m sure you’d fall over laughing at us trying to dance. They called up the “white folks” and so we presented our gift and then had to toss money into the baskets. It was Cristy, Ali, me, & Demitrio. I’ll just say that we were all laughing at ourselves and each other!! Most people threw in 20 kwacha notes which is about 10 cents so there was money flying everywhere with us laughing at each other! Then after a few minutes more people came up and joined us. We made a lot of people laugh and the next day at the hospital it was all people could talk about and tease us about.

The interesting thing about the money dance is the freedom and joy that was on the people’s faces. It struck me (and maybe this is deeper than it really was) but this is one chance when you really feel generous with someone and a chance to give away something to help others. When you are so poor, like the Malawians, it is not often when they can be carefree and just fling money around. What an amazing gift and chance to celebrate with each other as family and friends. I was so glad to be a part of the celebration. The bride and groom made quite a bit that day – over $1,000!!! That is a lot of 20 kwacha notes! We have heard many times and even from the groom how much it meant to them for us to be part of the celebration and join them. What a special chance!

Investigative” Accounting

I admit openly that I have never done auditing and it is not my forte to find what is wrong in the accounting processes. However the AHI-Malawi board requested that I visit the Adventist clinic in Lilongwe and do a bit of analysis on their processes related to inventory. So last week was the appointed time and I took a bus up on Wednesday the 4 hour ride. The clinic is made up of dental and medical services. There is a couple from the Philippines who are both dentists and have been there 8 years. The medical doctor is Malawian and has been there about 4 years. I hope that the suggestions I made will a) be implemented and b) be helpful. My feeling is that once they are in place if there is anything questionable going on it will come to light.

Cristy ended up having a meeting on Thursday in Liliongwe too so she stayed with me at the guest house and we both came back Sabbath afternoon. On Friday after I worked in the morning we went with Clare (a volunteer from the UK that used to be at Malamulo) and she took us shopping, out to eat, to a used book store, and we even found a place to get pedicures! Lilongwe is the capital of Malawi so the base for many NGO’s and ex-patriots so for a couple of days we got to feel like we actually weren’t in Malawi which was nice for a change. I even stepped on US soil when I went to the US Embassy to register. I also did my civic duty and cast my ballot for the presidential elections. I admit though, that by the time we got home on Sunday I was happy to see my bed and have my own space. Our little house feels like “home” and that is a comforting feeling.

There continues to be many challenges and recently our creditors have been calling me directly asking for payments on our accounts. Thankfully we had some money set aside and today we were able to pay about 1 million kwacha on our debts (~$7,000). That is a good feeling!! This last week we were able to make some arrangements to provide pathology reports for our patients at a reduced rate (from the one pathologist in the whole country). We also are going to have a pharmaceutical company manage the inventory of drugs and supplies at our clinic in town. This will be a major boost to the business there since people have been going to other pharmacies to get their prescriptions filled since we haven’t had the stock to sell to them. Slowly things might be looking up although I hesitate to get my hopes up too much.

Cristy is doing well. She is on call this week so it’s always more demanding. Fortunately the hospital is only a 5-10 min walk from our house so she doesn’t have to stay at the hospital. Last week she had a patient in her 30’s with Acute Leukemia and it was just sad because there is nothing that can be done here for her – even in the states her prognosis is bad – but in Malawi there is absolutely no treatment. Cristy had to break the news to her that she would die within 3-4 weeks which was understandable very difficult.

She (Cristy) has officially been appointed the Chief of Medicine so is continually challenged with the management side of the medical staff and various responsibilities. We laugh about how we are both inexperienced and have found ourselves in these leadership positions. It is sort of like the “blind leading the blind” sometimes. Thankfully we are confident in God’s strength and wisdom so that gets us through the tough days. We are glad to have each other and that we get along so well – what a blessing!!

I’ll close for now – there is so much more to write. Until next time --- e

Photos of My House

I've been delinquent in posting photos around the house... Here are a few hopefully it gives you a little better idea of where I live...This is the front porch. We live on the end of a tri-plex.
This is the front room. Notice the end of the piano on the left.We do have a fireplace but are not sure if it works. The carving on the left is a solid piece of wood and it is of a lady bending over with a baby on her back - very typical of actual life.
The kitchen - the stove is on the right just out of the photo and to my left is a small kitchen table.This is the view out the kitchen window. When it is a clear day we can see the villages down in the valley.
My room...
Just PART of Cristy's book collection. Never fear about my supply of books! This was before she brought back a crate of new books. Yes we also have a tv and DVD player.

I have to say I'm spoiled and really don't have much to complain about. I am thankful every day for being able to share a home and life with Cristy. We continue to make yummy food in the kitchen and are hoping to create a comfortable home that is welcoming to everyone.

It would be fun to have you visit "for real" but hopefully the photos help a little bit.

Observing Malawian Grief

Another week of experiencing life here in Malawi - this time it was a little more somber…

The Business Manager (i.e. Controller), Foster’s, elderly father was here in the hospital with a dislocated foot after a fall several weeks ago. After initially refusing hospitalization and trying some home remedies he came back to the hospital and was admitted with some large burns on his lower leg and foot as well as the bones still out of place. Monday morning Foster came to me saying they were going to surgery to amputate his father’s foot! I was surprised – not realizing that gangrene had set in and the only thing to be done was cut it off. I went to the ward and prayed with the family before he headed to surgery – feeling bad and wishing there was more I could do.

Later in the day, around 3pm the chaplain/HR director came and found me to tell me that the old man had died in the operating room. I later found out just as they were starting to cut he stopped breathing. They did CPR and compressions for about an hour before Foster told them to stop. His father was almost 90 years old and earlier in the day had told them he was dying and that he was ready. It seemed like his “time to go”. I felt so sad and just had a hollow feeling in my stomach. We went and told Don and talked about what the hospital would do for Foster in this situation. I asked if it was appropriate for us to attend the funeral and the chaplain confirmed my thought that it was.

Not sure what to do or how to be helpful I went on about my “rounds” and was playing with a beautiful baby outside maternity when one of the CNA-types came to find me. She asked if I had heard about Foster’s father and then said there was a group of people waiting outside the OR for the body to come out and be transported to the morgue. [Note of Explanation: The morgue is located at the far end of the hospital and whenever a patient dies the family and “guardians” accompany the people transporting the body to the morgue. There is no way or desire to hide the procession. The grieving is loud and very noticeable to the rest of the hospital.] I told her I wasn’t sure what I should be doing and asked if I should join that group. She confirmed that I should go and be there.

I felt out of place but joined the group of mourners (family and employees) waiting. They were quiet, some quietly crying. When the body came out on the gurney and we started our walk I trailed behind and just tried to absorb the process. By now the news of this death had spread around the hospital and many staff came out of the wards and just watched as we walked by. Although they couldn’t leave their duties they took a moment to be present as the family and the body came by. There is a covered place next to the morgue for families to wait until they can transport the body where we gathered and sat quietly except for the daughter-in-law of the man who died. She was the only one crying loudly.

I stayed there for about an hour… just sitting. People came and went it seemed like they came to show support and when they felt they needed to get back to their responsibilities they would go. Women took turns comforting the lady crying [Note: all of the women sat together on the ground while the men sat in the wall window openings/seats – except for me] and everyone else was just quiet. I thought at one point, “well there is nothing I can do, so I should go” then I realized there is nothing anyone can do – that isn’t the point. The point is just being here and being present in this grief of the family. The vision of the culture in this situation was beautiful – as Americans we strive, write books, and even create a whole industry in being “present” and “slowing down” and here it is normal life! People stopped what they were doing and what was most important that afternoon was to be present for this part of the Malamulo family. I started to think they should all get back to work, but then really – what is important here?

Wednesday was the funeral… we drove about two hours away to the home village of the family where everyone was gathering. When I asked what I should wear I was told color didn’t matter but I definitely needed a chitenge (3m length of cloth that is wrapped like a skirt over the top of whatever is worn – it is also multi-purposed for carrying babies on the back, keeping warm, etc). There were more than 200 people gathered and the family is expected to feed all of the visitors the day of the funeral. Don and I sat in the chairs under the mango tree with some other “VIP-types” (apparently the place of honor since no one else had chairs). After some time a small group of us were taken to a house and fed nsima, beans, and cabbage (normal local fare). Then after waiting for a while longer the ceremony started. There were a few speeches, some songs by a choir, laying wreaths on the coffin and then we all walked to the graveyard nearby; again more speeches, family ceremoniously putting a bit of dirt on the coffin and then the grave diggers quickly burying the coffin. It seemed like the sermons emphasized hope and heaven and encouraged people to stay close to Jesus as he is the “resurrection and life”.

Death seems to be so common here that at times I wonder if people are immune to it. Their grief is expressed differently than I’m used to so it sometimes seems like they are not grieving. I had a discussion about this with Foster not too long ago, and he said that he does feel like he has become used to it more since working at the hospital since it happens so frequently. But he also explained for himself anyway, when his mother died he cried openly for about a week or so but it took him a full year to stop crying in the privacy of his home.

Before coming to Malawi there were different things going on that made me more aware of the pain of other cultures. One was the earthquakes in China; another was some pictures we had at Convocation in IL. Both made me realize that people in all cultures experience love and pain but express it differently. Just because they don’t cry the same as I do doesn’t mean that they love their families any less or are less affected by death. I value this insight (although it seems obvious) because I want to have compassion for people and to feel the pain that they do when their loved ones are sick or dying. One of the hard facts of life here is the death of children. Malaria and HIV is a big threat to small children and too often they end up dying. There are many factors but sometimes I wonder if parents grieve for their lost child when it seems to happen so frequently. Does that make it any “easier”?

These words continue to comfort me:

“Then I saw a new heaven and a new earth, for the old heaven and the old earth had disappeared… I heard a loud shout from the throne, saying, ‘Look, God’s home is now among his people! He will live with them, and they will be his people. God himself will be with them. He will wipe every tear from their eyes, and there will be no more death or sorrow or crying or pain. All these things are gone forever.’” (Rev. 21.1, 3-4)

Ways to Donate

I have had a few people ask me about how to donate money to help support Malamulo Hospital and what things we are needing. There are many projects as well as just general day to day operations of the hospital... Here is a list of projects that I sent to one friend:

1. Buying new mattresses for the beds – about 180 are needed to replace ones that were falling apart, stained, and rotten and have already been destroyed. With the coming rainy season there is a huge need to be sure that the beds have mattresses – especially in pediatrics.

2. Water project – the water system is 50-80 years old and in dire need of repair. ADRA has funded a grant to get us started, but we will need about $300,000 more dollars to repair everything properly.

3. Annex Ward – we have a ward that is for the “VIP” patients (i.e. ones with insurance that can pay for it) that needs to be fixed up with paint, TV’s, the kitchen re-done, new linens, etc. The hope is to attract the higher paying patients which is possible with the good doctors here now. The cost will probably be $2,000-5,000 depending on how much we do.

4. General operations – we are struggling and in debt to quite a few creditors up to about $600,000 USD although we are now paying cash for the medications and supplies, it is difficult (if not impossible) to keep up.

5. Malamulo College of Health Sciences has many needs and the students from all 12 SDA colleges around the US have united to raise money and help support the college here. For more information on that you can visit www.missionatmalamulo.org

For sending donations the best option is to direct it to Adventist Health International click on "how can I help" at the top, then "Financial Donation". If you send me an email with the amount of your donation it will help us so that we can have the money transferred and used how you specify or for Malamulo in general.

The friend I sent the list to has already donated $1,000 and we are so thankful for this support!! The best promise is knowing that God has 1,000 ways to supply the needs of the hospital that we don't understand. Thank you for your interest in the mission here and the lives that are impacted by the hospital. Please email me with any questions...

Photo Update

Cristy on the porch - peacefully typing away surrounded by our neighbor's "jungle" of potted plants.
Our Calla Lily that bloomed a few weeks ago.
Me, Dr. Hart, & Jesse Crounse at Sabbath School.
Cristy and I after church the first Sabbath she was back.
The Kasamba family and me with baby Rebbecca.
Ali doing a grand job of duct taping our ceiling.
And.... the next day. I was standing by the sink when it crashed down!
This is the hole that is left in our ceiling. :(

Recipes

This is the bread that I've made a few times and really like!

Kalamata Olive and Garlic Bread
INGREDIENTS
• 4 cups all-purpose flour
• 1/2 cup warm water (110 degrees F/45 degrees C)
• 1 tablespoon white sugar
• 1 tablespoon active dry yeast
• 1 tablespoon non-iodized salt
• 3/4 cup warm water (110 degrees F/45 degrees C)
• 3 tablespoons olive oil
• 5 cloves garlic, minced
• 1/2 cup seedless Kalamata olives, chopped
• 1 tablespoon cornmeal
DIRECTIONS
1. In a medium bowl dissolve sugar in 1/2 cup warm water. To proof yeast, stir in yeast and let stand for 5 to 10 minutes in a warm place.
2. Preheat oven to 105 degree F (40 degrees C). Warm an oven-safe bowl in the oven.
3. Place flour in bowl of food processor. Add salt and pulse for a few seconds.
4. Start food processor. Pour proofed yeast into flour through hole. Immediately add the additional 3/4 cup warm water, then the olive oil. Process for about 1 minute or until dough ball cleans the sides of the processor bowl. If dough is too wet add a little flour through the top while processing, or if too dry, add a little more water.
5. Turn off food processor. Remove lid and transfer dough to the heated bowl. Cover with a plate or plastic wrap.
6. Let rise for 1/2 hour in a warm place.
7. In a small bowl, combine minced garlic and chopped olives. Set aside.
8. Once dough has risen transfer dough to a lightly floured board. Make an indentation in the dough and place olive mixture inside. Knead dough 10 times. Bulk of mixture should remain in middle of dough. Form dough into a log or round loaf shape.
9. Sprinkle cornmeal onto greased baking sheet and place loaf on top. Turn oven to 150 degrees F (65 degrees C) for 2 minutes and then turn off.
10. Let dough rise in warm oven for 1/2 hour, or until light and puffy. Remove loaf and increase oven temperature to 350 degrees F (175 degrees C).
11. Bake bread at 350 degrees F (175 degrees C) for 30 minutes or until loaf sounds hollow when tapped. Remove from oven and cool on a wire rack.


This is a curry with butternut squash that is really good too!

Sweet Vegetables
Cook until crisp-tender:
3 c. butternut squash, peeled & cubed

In a separate saucepan, bring to boil:
2 c. coconut milk
3 cloves garlic, minced
1/4c. onion, sliced
1 tsp. ginger root, minced
½ tsp. ground turmeric
1 tsp. salt
2 fresh red pimento or sweet red pepper (can use green too)
1 red jalapeno, thinly sliced (optional)

When boiling add squash and simmer for about 10 minutes to let the squash absorb the flavors

Options are that you can add squash directly into sauce without precooking. Simmer until tender. Also may substitute green beans, cut diagonally, for half the squash.

Serves 4-6