Update on Life

The past 2 months have seemed to be quite eventful but I’ve only written about my trip to Kenya. So I guess I need to write a brief update although I don’t really want to just have a “travel log” (maybe it’s too late to avoid that).

After the drama of being evacuated from Kenya I was happy to stay home and not even venture to town right away. I honestly have never been through something like that where I felt so emotionally traumatized. Whether the threat was real or not, I felt like it was real and had to work through the fear and stress that I had. I’m thankful for Cristy who was patient with me and for my family who called me and provided the support I needed though they couldn’t be physically close. I’m thankful to have gotten past those feelings and that I’m safe and not permanently affected.

About a week after getting back from Kenya I came down with malaria. This is momentous for me because it is the first time in 2 ½ years of living in Africa that I’ve succumbed! It is a strange disease and like nothing I had felt before so that was why I decided to go get tested for malaria. Sure enough it was a mild case. I took the treatment that lasts for 3 days and started feeling better by the 4th day. I didn’t have a high fever and mostly just felt drained and tired. My energy was slow to come back though and I didn’t work much at all that week. I then had some severe pain and congestion in my ears the next week but that also cleared up eventually. During this time Cristy was gone mostly so she wasn’t around to take care of me but my neighbors checked on me which was nice.

Thankfully Cristy’s trip to Kenya was uneventful and she had a good time at the continuing education class for missionary doctors in Africa. The most exciting thing was that we had planned a vacation to Victoria Falls after her trip so Cristy flew from Nairobi to Lusaka and met me there. Well it wasn’t just me - Fernando, Blanca, and Lety flew with me from Malawi to Lusaka then Anthony (who lives in Lusaka but worked in Malawi for a short time) met us there as well. We took a bus to Livingstone and spent 4 days there near the falls. Cristy was brave enough to bungie jump while the rest of us cheered her on. We went white water rafting, took a sunset cruise on the upper Zambezi and basically just relaxed and enjoyed the beautiful area. It rained a lot which added to the relaxation factor for me as the rain just makes me want to curl up and read or sleep.

On the way back in the bus Anthony and I got off near Riverside Farm. This is where I was a student missionary 10 YEARS AGO!!! (don’t make any comments about getting old!) Anthony worked there for about 4 years so knows everyone there and it was fun to go back. The main missionary family that I worked with is still there and a few of the Zambians that I knew were around. It was fun to see them and see how the place is doing. I can’t believe that the time has already passed and yes, I do feel old! The place is lovely and doing well so it was a short but sweet visit.

So my opinion is that vacation was exactly what I needed to recover from malaria and the emotional stress from Kenya. I feel back to my normal self and am so happy for that. Malamulo Hospital is doing alright - they survive ok without me (imagine that!?). Mr. Don is back now so I am no longer “interim CEO” which I am grateful for. Wes and Chrislyn are coming back in about 2 weeks and Dr. Fam is back from his holiday. My Mom asked if I felt like things are getting back to normal - I laughed and said I don’t know what “normal” is. But I think as close to normal as we can get is coming.

The hospital is busy this time of year with seeing 100-200 children every day in the out-patient and pediatric departments. Malaria is the main concern but there are also complications that come along with that. We have also been busy with quite sick adults and many surgeries and births. Thankfully due to financial help from the government children are getting treated sooner (with the fee charged to the government) and our mortality rate has dropped significantly in the past 3 months. Now we just need to have the government pay their bill.

Every day brings new challenges and new chances to be thankful. I had two days of meetings last week with the CDC office in Malawi and all of their partners who are receiving PEPFAR funds from the US government. I was representing Loma Linda University as part of a Laboratory Consortium so those meetings were very interesting and beneficial. There is a lot of good work being done related to HIV/AIDS here in Malawi and it was nice to hear from other organizations what their plans are and to network with Malamulo in mind.

This week we have the Executive Secretary of the General Conference of SDA’s, Elder Bediako visiting on Friday morning. The campus is buzzing with activity – weeding, painting, polishing and general spiffy-ing up until the place shines for this church dignitary.

I also feel challenged personally to stay focused and to continue to feel like I am adding value here as well as fulfilling the job I was given. I have gotten the question “so how long are you staying in Malawi?” many times in the past month or so. I don’t have a good answer at this point and right now am just planning to continue here unless something happens or I am directed to go somewhere else. My initial agreement is over in July of this year but it seems as though I will be here longer at this point.

HOME

What do you think of when you hear the word “home”? Maybe it’s a childhood house, a street, a school that identifies home to you. Or maybe it is where you live now – with your pets, kids, and spouse. What has made that place take on the meaning of “home” to you? At some point we leave our childhood home and venture out to create our own definition of home. Is there something that identifies this place as home? I heard recently of one family who were always moving around and the Mother had a vase and picture that she always kept with them and the children soon associated “home” with those items and when the vase came out of her suitcase and the picture went on the wall – then they were home.

At the recent missionary training class I attended these questions of “home” came to my mind and I realized that for the first time, I think, I feel that Malawi and the house that I share with Cristy is home. Some of that feeling was triggered by the somewhat traumatic experiences that our group had while in Nairobi and my feeling that I would rather be in Malawi where it is safe, but I think also just being away I realized that it is home to me.

When I think of the places I feel at home a big part of it is my comfort of being myself. However “being home” and “feeling at home” are two different things. I can “feel at home” anywhere were the host is welcoming and where I feel comfortable. However feeling like “I am home” is a different level. Part of this is related to having a few special things around me but also just feeling at ease with my surroundings. It was especially made clear to me on Thursday night the 21^st when we were instructed to pack our things and evacuate out of Nairobi as fast as possible. I no longer felt safe there but I was surprised that I didn’t have a strong desire to go back to the US – to my family. To me, right then, “home” meant feeling safe and I associated that with Malawi. This realization surprised me.

There have been times when I’ve said “home is wherever I am living” and that is probably because I haven’t lived in my childhood home since I was 14 years old. Maybe this perspective has contributed to how comfortable I feel about traveling and living abroad. Now, before my family feels bad I think that my childhood house will always have a special place in my heart and will be one definition of “home”. Those walls, the garden, trees, and hills are where I spent my formative years and are firmly imbedded in my memories. But in reality their house has become theirs’ and not mine which is ok and part of the growing up process.

I guess the definition of home might change over time but I have a new appreciation for the comfort and rest that having a place to come back to brings. It also reminds me of the promise of God to be our source of protection and place of safety (Ps. 18:2). This can be our home wherever we find ourselves.

Request for Photos

I haven't posted any photos for a while so I thought I'd just post some here. I am in Nairobi for 3 weeks attending Institute of World Missions so am excited to have speedy internet which makes this easier. It is a good class, I am learning a lot and feel privileged to be included since I'm not an official GC employee. I have posted more photos on Facebook so if you want to see more go to my page and check them out.

Senga Bay, Lake Malawi

Cristy, Anthony, & Me (Christmas Day

Me and a little girl in Nagwengwe village

Scott Guptill and I (Mindi was taking the photo) eating Indian food at the Yaya center in Nairobi - notice the copper pots for the curry! YUM

Soap stone workshop in Nairobi - this is where the items are painted before sold in the markets

Plumeria or Frangipani blossom (photo by Cristy)

Our house decorated for Christmas (thanks to Kelly)

Hobbes pooped out after all the decoration!!

Christmas Miracles

This is an email I sent on Christmas Eve to family & friends. Wanted to post it here for you as well...

Merry Christmas to You!

This year is ending and it always makes me nostalgic – both for family and friends but also memories of this past year and how God has blessed. Last year this time we were rushing to make up some Christmas gifts from a few things we bought and some donated items so that the hospital employees would have at least “something” from the hospital. We scrounged enough money to barely have a Christmas party with a few snacks thanks to a donation from a friend of mine. The salaries were barely distributed before New Years, let alone Christmas last year. Yet still we remained optimistic and tried to put a good spin on everything so that morale would continue on its slow climb upwards. Throughout this past year we have steadily seen improvements in the financial performance of the hospital. Partly it is due to an increase of about 20% of inpatients over last year, but also our cash flow is improving as well which is really what makes an organization function.

So this week I find Christmas miracles surrounding me – instead of me shopping and packaging Christmas gifts for the employees we were able to buy them pre-packaged (it’s tradition to get rice, oil, sugar, salt, soap, & matches and there are stores that package them for you if you pay for it) and employees were surprised yesterday to hear the announcement that their Christmas package was ready to be picked up! Also people like to be paid before Christmas and for salaries we are dependent on a government grant. We prepared payroll in faith that the money would come through and yesterday it was deposited and people are able to get their money! We have also made our supplies and drug purchases for the month and I’ve signed a pile of checks for various purchases that have been waiting for quite a while. The most amazing thing is that we have money to cover all of the checks we’ve written – which you might not realize but is a miracle in itself!

Last week after being delayed about a month we had a delivery of two containers from AmeriCares (our large donor in the US) full of medical supplies and medication. That was 60 feet of materials delivered in one day!! The stores staff and others worked tirelessly to unload everything and then continue sorting things the days following (a never-ending process). We are so thankful for these donations and specifically the nutritional supplements for the malnourished children – the meals are already being distributed.

Personally since returning from my visit home I have been busy – just keeping up with everything I feel at times that I work non-stop. But thankfully I’ve had the chance to take frequent breaks. In November I climbed Mt. Mulanje with some friends and felt very proud of myself for surviving although we didn’t summit. We had a group of officials from the US doing an “appreciative inquiry” the week of Thanksgiving both here and at Blantyre Adventist Hospital. They brought some welcome encouragement and support. For Thanksgiving about 25 of us got together in Blantyre and made a feast as close to traditional as possible – complete with the overeating feeling at the end! There are more folks from the US now that Maranatha is moving their base to Blantyre from Mozambique as work is wrapping up there.

Overall I am doing well – I have no reason to complain. Cristy and I and some friends are heading to Lake Malawi today for Christmas and we are looking forward to enjoying white sands and a tropical lake. Granted - it’s not like Christmas at home but as I told a friend this morning – it’s white sandy beaches, I can’t complain! J I do miss my family dearly and wish I could be at the table tomorrow and share all of the wonderful traditions that we have. Thankfully we have phones and internet which keep us connected and a time in the future to look forward to being together again.

As 2009 comes to a close I am again just overwhelmed with thankfulness for each of you and your thoughts and prayers. There is still a lot of work to do here but I am just excited to be part of the changes that are happening and continue to happen. I know there are more challenges ahead but I am confident that the miracles of Christmas will continue through the new year. Blessings to each of you!

Merry Christmas!

Elisa

Haven't Posted For A While

These were written on the dates indicated but I just haven't had a chance to post them...

11-23-09

Holidays?

Is it the holidays somewhere? Not in Malawi… we will try to squeeze in Thanksgiving this week but it happens to be the same week as the “Appreciative Inquiry” from the General Conference of SDAs in Maryland. One of my friends thought this term was rather like an oxymoron – along the lines of “freewill offering” or “military intelligence”. I’m not sure what it means exactly (I’ll hopefully find out tomorrow) but mostly it means a group is coming to analyze how the hospital is being managed and how it is performing. There is no licensing or governing power associated so we aren’t really sure what the purpose is. It has helped to get some things done around the hospital – the open wires are covered, window screens are repaired, broken glass removed and fences repaired. We’ve also just started getting new name badges printed and distributed so people are officially employees and identifiable now! Imagine that!?

My recent weeks have been busy and gone quickly. I’ve spent a significant amount of time trying to get some shipments cleared through customs. That has been a painful process and unfortunately the Malawian Government is becoming stricter in an effort to raise funds. They don’t consider replacement parts for equipment as “medical equipment” so essentially you can get the equipment in without duty but if you want to repair anything you have to pay tax. Sometimes working within these regulations is overwhelming.

Our record keeping in the accounting office has been very disorganized and insufficient. After our poor performance on the 2008 audit I had a meeting with the accounting staff and they decided to work extra and come in on Fridays until noon and get things organized. I’ve committed to come in and work with them. I’m proud of them for working hard and taking ownership. Some have really come up and showed some good leadership and I’m excited for the progress. Everyone shows up and works together and they are getting a lot accomplished. However this is my day off so this work takes up my time too.

I have managed to escape the hectic days a couple of times. Two weeks ago I went with four friends and climbed Mt. Mulanje! We only spent one night up on the plateau but it was one of my goals while I was here and I’m proud that I accomplished it! We were about 6,000 ft up and didn’t attempt to reach the summit which is close to 10,000 ft. We only went to the closest “hut” and there are nine huts on the mountain so I’d like to go back again and spend two nights and see more of the mountain. But I enjoyed it – the pain was worth it! I even took Bella with me and she did really well. Maybe next time I can actually carry my own pack the whole way!

Yesterday Cristy, Anthony, & I went for the day again to Mulanje and just went to the waterfalls that we’ve been to many times. It was Friday so I came in to work with the Accounting staff until about 10a and then left them to continue cleaning out files. Even though it is a drive to get to the mountain I am so thankful for that refuge – the peace, fresh air, and water does so much to refresh my soul!

Last Sunday I went and visited one of Malamulo’s remote clinic sites. It is called Mbalanguzi and is about 25 kms from the hospital but takes about 1.5 hrs to get there (and that’s with dry roads). We have a large amount of land with a clinic and a house on it. No one staffs it full time but there is such a need! I met with the chief and discussed bringing water and electricity to the site. There is also a need for a maize mill which would generate income for the clinic. I’m kind of excited about the possibilities out there mostly because of the desperate need for healthcare! They see about 50 patients every week and that day we brought about 10 patients back to be admitted to the hospital. The chief said his main concern is maternity, malnourishment, and those who are sick at night and die on the way. The nearest clinics to that site are 8 kms one way, and 7 the other. Malamulo is the closest hospital but there is no transportation out there except for the occasional lorry or truck headed to Makwasa. Talk about remote! I was wishing that I were a doctor or nurse and could be of some benefit to the people. As I am there is nothing I can do except figure out a way to make it habitable so someone else can go out there – that’s something I guess.

So is it the holidays? I honestly don’t know. I know the calendar says this next week is Thanksgiving and 4 weeks later is Christmas but I’m not in the spirit. I have to be at the Malawi Union year end meetings all next week – maybe I’ll slip out early on Thursday for dinner at some friend’s house. Christmas seems far away and I don’t have any plans. I guess being busy is beneficial in that I don’t have time to miss my family as much. But it also means I don’t have the time to enjoy the people here or the things happening around here as much.

11-27-09

This week has been challenging in many ways. I spent three days with the team from the GC. Both the days at Malamulo and the survey at Blantyre Adventist Hospital went well. Dr. Handysides and Dr. Landless were leading the team and they are both very wise, encouraging, and generous gentleman. They were also quite fatherly to Cristy and I which is always nice. J We like being taken care of! They had many good recommendations for Malamulo but many of the things we were already aware of and most of the things require money to fix or improve. It sounds like they will be able to give us some money but we haven’t heard how much for sure yet. Their visit to BAH was beneficial too and it was amazing to me how wisely and quickly they realized what the issues are. They were very supportive to Kirby and the initiatives that he is working on. They were very direct in their recommendations to the leadership of BAH. A couple named Ed & Ann Zinke were with the team and were evaluating the business side of things. They just sold a large business and are semi-retired. I spent some time with them and really appreciated their insight and encouragement.

The GC surveys overlapped with yearend meetings for the Malawian SDA church. I spent a couple of days in those meetings and then was able to be excused for Thanksgiving dinner. We invited everyone we could find and had about 25 people over at David and Susan Woods house in Blantyre. They have a 7 bedroom house so lots of room for visitors and interlopers like me. He is the country director for Maranatha for Malawi and Mozambique. It is so nice to have a place to relax that is homey. Cristy cooked up a storm and everyone else contributed as well. I guess that is what Thanksgiving is about – food, friends, family, and friends.

What Am I Doing Here?

Ok - I hate to admit it but this question has been going over and over in my head... is the work I'm doing here really making a difference? Am I accomplishing the purpose that I or the organization I'm representing had in mind? Now those of you who know me well, just wait! I don't mean to be-little what I have been doing and play it down. I know my Mom gets after me for not REALLY explaining what I ACTUALLY do when people ask - that is not what I'm trying to say here. But honestly I'm asking myself if I'm really accomplishing what I'm supposed to be doing. Maybe I need to look at my job description again - I don't know. But today we had an exit interview with our internal auditors who just finished auditing 2008. The final report is not out but suffice it to say that everything that was on the letter for 2007 reappeared with some additions for 2008. Our qualified opinion for 2007 did not improve! (For you that are not accountants this means that if it was an exam - we failed.) So maybe you can imagine some of why I'm questioning my effect here. Has any of my last 15 months of work made a difference? Maybe you are thinking that it has because they only audited through 2008 which was only about 5 months after I arrived. But the problem is that most of the items they pointed out have YET to be corrected!!!

I find it very difficult to know how to change a culture of this organization. How do we implement controls and motivators to get people to move from the lazes fare attitude into one of commitment and active participation in the mission of this hospital. I'm "all fired up" as some might say and ready to give 'em a piece of my mind. At the same time I can't do this alone and be the only one demanding good performance and results from our employees. I do feel the members of Administration are supportive and in tune with these changes but I'm struggling to find a way to communicate it to the staff members.

I find my "to-do" list growing too... big things like "customer service training for all staff" and "job evaluations for all staff" - which by the way first requires a training on how to properly evaluate an employee before evaluating all 200 employees. Another thing is policies for all departments. Wow! I think if I can do half of my list I'll feel good.

So yes - I'm still searching for the answer to my question. What is my role? How do I focus on these big things and let the every day items be handled by someone else? This is my daily challenge and I am learning about limits and commitments as well. I bet you didn't think mission work included things like this, huh? So when you pray for the "missionaries and colporteurs" tonight before you sleep you might have a different viewpoint of missionaries these days... and realize a little bit more clearly what kinds of things we struggle with. Thank you, by the way, for those prayers. I think that is what keeps me from losing it some days!

Life Goes On...

But how does it go on? How do the living pick up after the dead and sort out what was left behind? What do you do when it’s sudden, unexpected, and unprepared for? How do you encourage those left behind wandering through the mine field of grief? The words of an old song summarize it all, “how can I help you say goodbye?” Maybe these questions would apply even if you expected to lose someone but this week it was sudden and unexpected.

These questions have been bombarding my mind and I find myself wishing to just erase a day from history – is that possible? Can we rewind and do things differently? I wish with my heart we could and mostly that we could have seen the signs of depression or a loss of a will to live before this happened. I could go on and on with “what if’s” but I’ve already realized that is not profitable or even realistic.

So you’re probably wondering what happened by now – I’ll try to explain without being too long-winded. He worked in our business office as the “credit controller” or the one who recorded payments patients made on their account and collected money from the insurance company and other payers. He had only been in this position since the first of the year and before that he was manager of the inventory and stock warehouses. As you can imagine I’ve worked quite closely with him over the last year that I’ve been here. The week before last it was discovered that in an effort to be “helpful” he offered to turn their money in for them and give them a receipt from a different book (still Malamulo but not from the cashier so not “on record”). The accountant met with him that day and then the next business day was I along with several members of management met with him and gave him a letter of suspension and explained we would be reporting this to police. The amount of money was not astronomical but we felt it should be reported to authorities for documented back up for termination.

He was calm and admitted to everything both verbally and in writing. There was no anger visible although he was understandably nervous. Afterwards we planned to take him to the police department so he went back to his house to lock up the doors. So a little while later I went with the accountant and the HR manager to report it to the police. We wanted to take him with us but couldn’t raise him on his phone. We all tried several times but thought we’d just go anyway and make the report. We brought the police officers back with us to find him. All of this should only be done, they told us, after we contacted his closest relative. After realizing he had no wife or children his next closest relative was a cousin who works at the hospital. We stood and discussed things for a while – should we break in? What if he’s not there and sues the police? What if he is there and we are wasting time?

Finally we went to his house and decided to break in. They quickly opened the door (amazing how easily they know how to break in!) and it was confirmed that we needed to RUSH him to the hospital as he had taken something and was non-responsive. We hadn’t come in a car but were right behind the hospital in the housing block so I took off running to find the ambulance or some vehicle. (Picture me in a dress with 3 inch wedge heels RUNNING past all the ladies chatting that I had just walked calmly by.) I got to the front of the hospital – no vehicle! Someone else ran to general ward and got a canvas stretcher. I turned around and was trying to call at the same time to find the driver – phones weren’t working!! On my way back (by this time I took off my shoes and was barefoot) I saw Cristy and urgently called her to come with me and told her briefly what I knew. I thought if there was anything that could be done at the house she could help until a vehicle came. We walked/ran back to the house and both cars were there that I had been looking for!! (Thank God for Malawian telepathy!)

The next two hours were spent intermittently waiting, praying, comforting people and grinding charcoal into powder. The team of doctors, nurses, and other medical personnel worked frantically to bring him around. Things started to calm down and they moved him from a treatment room into a patient room. I had to go check on some things around the hospital so left. I was hopeful in what seemed like “stability” so figured things would be okay. As I was coming back about ½ hour later someone told me that he had just passed away!! I was in shock! I walked in and saw Cristy who was visibly shaken as well. I went into his room to pay respects and tears overwhelmed me.

I cried because I was sad for him… sad that he felt this was his only solution… sad that I had just seen and talked to him and now he was dead… sad that I hadn’t been able to see his pain or help in some way. I stayed around as employees came and filed into the room. After they’d come they lined up outside the ward on the lawn, in the hallways, and everywhere they could. They were sitting in respect and mourning. Some were crying but most were silent – no chatting, no questions – just quiet. (Something I value about grief in Malawi – the practice of just being present.)

Meanwhile I spoke with some family members and close friends, the police, found Don and walked with him up there, waited for decisions to be made, and generally just tried to absorb the feeling of sadness and grief that filled the air. The funeral and burial were the next day at a nearby cemetery. It was a different service than I had attended before. There was no singing and very little preaching. As we walked from the house where the funeral was to the burial there was no singing and actually not much weeping. After asking about why these differences it seems that the community acts out their judgment on someone who takes their own life saying that “God is angry” and “there can’t be any singing when someone kills themselves”. Apparently even the short homily by the pastor was not really acceptable in this situation! I was surprised at the harshness and a sentence of damnation pronounced by those who are left behind. Obviously a difference in culture and religious beliefs but also doesn’t portray the God that I believe in.

So the days move on and we do have to pick up after the dead – whether we know how or not. We are busy sorting through the office he left and the work he did or did not do; moving people into places and at the same time being gracious at the accusations that are flying very unfairly. The verse in Paul’s writings that say “My grace is sufficient and my strength is made perfect in weakness” keeps ringing in my ears and I believe it! His grace IS sufficient and has been the strength that I am relying on.