THE BLOG

In this space I will post stories, events, photos, during the time I live in Malawi, Africa working with Adventist Health International. Please come back often (or subscribe) and comment frequently so that we can be connected.

Thursday, April 29, 2010

I Wonder What Will Happen Today?

I hesitate to hear the answer to this question this week. It seems like every day there is more in the dramas of the operations of this mission hospital. The past two weeks it has been a financial crisis. Our accountant came to me with a stack of purchase requests to sign for needed medicine and medical supplies. I knew it was a lot and when I saw the summary of outstanding purchase requests my heart stopped at the 3,600,000 Kwacha number and realizing we have NO MONEY in our checking account! Those requests went back on the accountant's desk to wait until we could scrape some money together. Each day though - something has happened and somehow we are scraping by.

Day 1: We HAVE to place an order on a certain day with CHAM (where we get good prices on medicines) so that they can deliver them to Blantyre rather than us driving all the way to Lilongwe. Our order this month was around 750,000 MK. We had only about 100,000 MK collected from two days of business at the hospital. Don happened to be in Blantyre and I asked him to stop by Blantyre Adventist Hospital and pick up the check for 560,000 MK that they give us every month as charity assistance. That along with a little more scraped together was enough to cover the order and it was placed and picked up 1-2 days later.

Day 2: We are owed over 7 million kwacha by the government for services given to people in the local area around the hospital (this is close to $50,000 USD). They have promised payment by the 15-18th of each month. It was past the 20th and we still had no payment. Every day we call to see if the check is ready and they tell us to wait until the next day or day after. I'm starting to have visions of not making payroll, completely out of meds, and not being able to function. Today we had to use cash to buy fuel for the car that goes to Limbe because there is not enough money in the checking account to write a check.

Day 3: Administrative Council today - we had a good meeting - there are lots of good things happening and some progress being made towards installing a V-SAT for satellite internet! (YAY!!) We also have Maranatha visiting next week wanting to come with a large group to do some work in 2011 so the potential for great things - and most of this done with donations. At the end of this uplifting meeting I had to give an update about the state of our finances and how we are really scraping bottom!! Not only do we have about 3 million of purchases to buy this month but we also owe about 2 million for insurance as well as other creditors that I don't even want to list. We ended the meeting with earnest prayer for this situation but I still felt like "Debbie-Downer" and also felt emotionally affected by the pressure.

Day 4: Amongst the other days we've been dealing with a 40' container of supplies delivered from the US. It has been a disaster from the beginning since the shipping company in Tanzania sent a driver who knows no English or Chichewa, had never been to Malawi before, and didn't follow the customs requirements! Inside the container are much needed medicines and supplies that we haven't been able to purchase but we can't open the container to unload until it is cleared. Today Don went to Blantyre to sign the papers and clear it without having to pay any duty (Thank You, Lord!).

Today I called the government hospital again to check on the payment that they've promised. After telling the accountant that we are reaching an emergency state and may have to end the agreement and close the hospital he still said we couldn't get the check until "tomorrow". When I asked him how much it would be he got angry. I explained we need to know for planning purposes and he then told me "You'll get the check tomorrow, whether it's one cent or a million kwacha you'll get it tomorrow!!!" and then hung up on me! I called the Doctor in charge of the district and discussed how his accountant acted as well as our concerns about their delay and lack of payment. It seems we should be collecting the check tomorrow.

Day 5 Today's the day that we are supposed to get the check from the government and a large amount from the big insurance payor in Malawi. Salaries are due this week as well. I feel snowed under by all of these things and have even delayed meetings and other things until we can buy enough paper to make photo copies. The priority is the medicine and supplies to keep the hospital running. The other things will come eventually.

This is my week... I appreciate your prayers and I know there are many who are already praying and claiming promises in response to these situations. I do think these are just some roadblocks and the general progress of the hospital is still in a positive direction. We also need wisdom to make good decisions with the resources that we DO have. The promise that says "He will supply all of your needs according to his riches in glory" is an encouraging statement right now and I believe it is true...

Sunday, April 18, 2010

Normal Life

1st some photos - this is from our trip to Victoria Falls - Blanca, Lety, Cristy, Fernando, Elisa, & Anthony
 
me in front of Vic Falls "the smoke that thunders"
The photo above is Mt Mulanje of my last post and a rainbow. It is beautiful!

I’ve been chastising myself for not posting more often so I think I’ll write something and try to be brief. I’m in Blantyre for a couple of days (thus some decent internet) and am enjoying a much needed break from things at Malamulo. I worked Sunday-Friday so was so thankful for Sabbath and a chance to just relax.

Today Cristy and I with a few others went down to Nyala Park in the Shire River Valley. It is a small-ish game park that we’ve been to many times. The three who came with us hadn’t seen any “big” animals in Africa yet so it was fun to experience the giraffe, zebra, nyala, impala, wildebeest and various birds and scenery with them again.

I recently picked up a book that I have been reading off and on since 2006. It is Dallas Willard’s “Divine Conspiracy”. It is excellent regarding the Sermon on the Mount (or “discourse on a hillside”) although I find Willard a little heavy to read. I guess that is why I’m still plowing through it and it’s been 3+ years! I enjoy it though and have been reading a little bit at a time. I’ve also just almost finished an epic novel about Australia that was a bestseller in the 70’s when it was written called “The Thorn Birds”. It is interesting to read about life in Australia – something I know nothing about. Since I finished that I just started a classic by Annie Dillard “Pilgrim At Tinker Creek”. It is in the same genre as Thoreau’s “Walden Pond”.

I have begun to think and pray about my future as my two year agreement is nearing completion (July). I don’t have any strong leadings or impressions as to where I should go – either staying in Malawi or going back to the US. But I also haven’t put my resume out anywhere in the US either. There are a lot of good things happening in Malawi – but I don’t know if I’m meant to stay and continue on. I would appreciate prayers for this.

For now, I’m enjoying all of the “comings and goings” of visitors, missionaries, and volunteers as spring seems to bring lots of different people around. I’m also looking forward to my trip to the GC in Atlanta in June. I’m close to be able to counting down the weeks and days.

Back to work this morning (Monday) with errands and people to see in Blantyre. We’ll attend choir practice tonight before heading back to Malamulo so it will be a long day. Blessings abound though and I’m grateful for many things – family, friends, health, and a beautiful place to live.

Friday, April 9, 2010

Sharing SHARE

Upon arrival in Malawi anyone will realize that the concept of “Customer Service” or “the customer is always right” is as unheard of as 12 lane highways, “high-speed” internet, and Taco Bell. The second realization if you come to work in a hospital in a management position is that there is GREAT NEED for training in this area. The third thing to come to mind is “where in the world can we start to teach this?” At this last point is where I have spent the last year or so. Not long after I came I contacted my former employer (Adventist Health System) and asked if they would let me use the customer service program that they use – designed for healthcare employees from an Adventist perspective. They graciously mailed me the training manual, the powerpoint presentation and some of the props and materials.

Every month or so I would look at the binder and flip through the slides and wonder how in the world to make this apply to Malawi and then give up being daunted by the task. Finally in October we decided in our strategic plan that customer service was a priority and my name was attached to the task. Now it was on paper which made me realize I cannot procrastinate very much longer. Finally in January I finished modifying the power point presentation to be what I thought would work here and what seemed like it would fit into 4 hours.

This week was it – the first session. The goal is that every employee will attend this training (200+ employees) and it will be two sessions, each two hours with 20-25 people each time. I talked to the matron, put up a sign to advertise and wondered if anyone would come. Wednesday and Thursday this week were the first sessions. About 20 people completed the four hours. They weren’t the nurses the matron had assigned but rather a mixture of people – so translation was needed which I did not account for in my preparation for a four hour class. Although I had to skip a bit of the points I was able to cover the topics as an overview and am hoping for opportunities to emphasize each point. So what did we cover?
Reputation – what is it? what kind of reputation do you want? what about the hospital?

Loyalty – what does this mean and what is the difference between loyalty and satisfaction?

What is customer service?

SHARE acronym – Sensing others needs before they ask, Helping each other out, Acknowledging people’s feelings, Respect the dignity and privacy of others, and Explain what is happening.

Body language

All of this sounds good but as we were going through the presentation I realized the slides and concepts I thought would work didn’t always make sense in this context. Also teaching in a setting where English is not the primary language caused challenges. How do you explain the statement, “patients judge their experience through their perception which is subjective not based on outcomes which is objective”. Those are big words and have to be explained and simplified or illustrated on the spot. I found it challenging to teach with a cross-section of the employees because about half of the people were the housekeeping staff and some don’t know how to read or write while the nurses and secretaries are quickly answering questions, taking notes, and filling in the worksheets while I’m not even sure some of the cleaners understood a word that I said. How do you teach to all levels?

Another interesting dilemma was talking about respecting the dignity and privacy of others. First when I asked what it meant they thought I was talking about respecting your elders which is one of the tenets of the culture. I said not exactly but more looking at how people are different yet treating them all the same. We looked as some pictures of different people and situations and illustrated how people felt differently about the photos and it is based on upbringing, etc. But how is Malawi diverse? It is completely different than the US – it is mostly a homogenous culture here but yet there are subtle differences in social standing, tribal differences, family values, religion, etc. I did approach the subject of how people are treated based on how they look. If someone is poor are they treated the same as someone who is rich? What about people from another country? or someone with white skin? I emphasized that white people should not be treated better than anyone else rather that everyone should be given the same excellent care. This was responded to with nervous laughter which means they knew that it is common to treat the “rich white person” differently. I wonder if they’ve heard a white person talk about this before? I think it’s important though and something that needs to be said and probably important for a white person to say it.

Then we talked about PRIVACY!! I recently had a discussion with Kelly about what is actually private here. The answer is basically the bedroom and the bathroom – that is it – not your kitchen, your yard, or the porch. So the concept of not talking about your neighbor who is admitted into the hospital is a foreign concept. Knowing your friends’ business is normal. What kind of privacy can we teach? So I used the illustration of HIV status which is still not talked about widely. This they understood but I didn’t know where else to go to teach about privacy because there isn’t much else that is culturally private. I realize I can’t change the culture and that is not my intent so the challenge is to adapt to what make sense here.
So the first class is over. I have some modifications to do to the presentation.

Also I have a better idea of some of the things that work and things that don’t. I hope the next class will go more smoothly and that overall our staff will begin to incorporate these ideas into their work. The goal is that Malamulo can be a preferred choice for patients to come for healthcare. That isn’t just sound clinical care but also good personal attention and customer service… Is it a “pie in the sky” kind of dream? Maybe, but I’ll work hard to do what I can to move towards that goal. As my good friend Phyllis always says, “hope springs eternal” and I continue to have hope that something I’m doing here will actually make an impact.

More Reflections

When I think about writing a blog post I always feel like I don’t have much to say. I guess since I’ve been living in Malawi now for 22 months there isn’t much that seems newsworthy. Yet when I take a step back and consider my “average day” from a distance I realize how blessed I am and can see the little things that make life enjoyable here. It also helps me remember why I am here and what my purpose is. So I wanted to just share some highlights from this past week – little things or big things that I have enjoyed or noticed and been challenged or blessed by…

Sabbath – drove to Mt. Mulanje with Cristy, Anthony, Ashwini, & Kelly. We met Ben there at the pizza place. Above our table there was a swallow’s nest with a mama swallow coming frequently to fill the giant yellow mouths. Cristy got a photo. We had ice cream with chocolate sauce! The mountain was beautiful as usual but this time with many trickling waterfalls down the face because of all of the rain. Anthony and I went hiking to a big waterfall with a pool and we jumped in the cool water – it was beautiful. As we left the sun was setting and it started to rain so on one side was the mountain hidden by a rain cloud with a rainbow arching over the top, the brilliant green of the tea fields was amazing contrasted with the gray clouds and the dark green of the mountain in the fading light. On the right side the sun was setting with gold, pink, and yellow. I didn’t know which way to look to absorb the breathtaking beauty surrounding us. Neither photos nor words do justice.

Monday – back at work with a busy day – catching up after “skipping” Sunday. In the afternoon I met a group from the USA with an organization “physicians for peace” traveling around Malawi looking for partnerships where they can send medical professionals to assist with training and teaching. I gave them a tour and talked with them about Malamulo and what we do and see here and what the needs are. Who knows what will come of it but we are always happy to have people visit and find ways to assist if possible. Wrapping up my day two officials from the SDA church came into my office to discuss some “concerns”. I seem to be an innocent by-stander in a disagreement so am just trying to be polite and answer the questions as best as I can. I won’t explain it all here but I just hope that the differences can be worked out. It is difficult to work here at times when it seems like the efforts to improve efficiency of processes is blocked by those who wish to be in control.

*skip a few days*

I’m back with some more time to write some reflections about my current work. Last weekend was Easter and I had another lovely day driving to Zomba. There is a plateau there and we drove up to a lodge about half way up. The view is beautiful – I can’t describe it. Anthony and I met Cristy and Kelly who were staying at a small lodge way off the road. It is in a beautiful location and we enjoyed the peace and quiet for a couple of hours. Then we drove up to the top of the mountain and had a late lunch before driving back to Blantyre and on to Makwasa.

I have to be honest reading what I’ve written sounds like every day is ideal and beautiful. This is NOT the case as is true with any job. The other day one of the senior lab technicians came into my office to tell me that the machine that does CBCs was not working and they had called the technician. When I asked him if regular servicing had been done he said, “No, it was supposed to be serviced at 10,000 tests and it is at 14,000 now”. He said this with a snicker. I have to say the lab is a constant challenge to us and once again I expressed my concern – in a strong way – that it is NOT ACCEPTABLE for them to ignore maintenance like this and that they are the only ones who know when these things need to be done. I told him that they need to take responsibility and come to administration with a quotation, deadline, and request for what is needed. They can’t just mention it and then give up. He said, “well I thought the head of the lab had taken care of it” and I explained that yes – maybe you thought that and he may have thought you were taking care of it but then NO ONE does anything. This is the problem, I explained, in that good communication does not happen so things are overlooked.

UGH!! Only 6 more weeks until we have a new couple from the Philippines coming to take over the lab and help turn it around. Cristy and I cannot wait for that to happen because over the past 2 years that Cristy has been here she has been unable to make much of a difference in the way the lab operates. It is like a walrus (as my friend referred to obstacles) in our path to good service here. Part of the challenge is the two senior lab techs are close to retirement and have worked their ENTIRE career here at Malamulo – almost 40 years! The saying “you can’t teach an old dog new tricks” is SO TRUE! They are both wonderful gentleman, but…

So today is Friday and I’m “off” of work. I am heading into Blantyre later. What does this mean? I plan to meet our dentist at 11am to look at a potential house for her to move to in Blantyre (nearer her office, her daughter’s school, and freeing up a house here on campus for us), then I have to take some paperwork to our clearing agent for two 40 ft. containers of medicines and supplies that are on their way to us (donations), then I will be able to go grocery shopping, eat some lunch, and probably post this blog on the internet. I might stop and see a friend or two but then will need to leave in time to stop at the big vegetable market on the way back out to Malamulo.

For the past month we’ve had a FP resident here from Pennsylvania who is Indian by origin. She has been cooking up wonderful Indian meals for us on Friday evenings so today is her last day here and she is planning to come and cook again. Last Friday we had 13 people here and the power was off all day! THANKFULLY we just purchased a gas stove and were able to hook it up in time to start cooking for the crowd. Tonight we won’t have as many people but we are looking forward to the evening with friends, good food, and welcoming the Sabbath. Thus the important stop at the vegetable market on the way home this afternoon!

Life here is never boring – for sure! The other day one of our nurses asked me if I was a Jew! I was confused at first and wondering if she was asking about my religion (sometimes people think I’m not SDA since I don’t attend church every week) so when I clarified she said, “no, there are so many races in America and I was wondering if you are Jewish”. Haha – I said no and explained that I’m a mix of German, English, and Danish. That satisfied her but as I said – it’s never dull and you can never be sure what question will come up next! Until next time…