What up DOC?

(Front of Malamulo Adventist Hospital, Malawi)

Benson came running to find me, “Mommy, Mommy....Daddy is laying down on the grass, he's not moving, come Mommy.” I saw the urgency in his little face and felt the concern in his words, and quick stepped out to the driveway where they had been plucking mangoes from our tree. Ryan was in an unfortunately familiar position hands clasped around his knee, writhing in pain. Suddenly I felt miles from anywhere. Miles from family, friends and definitely miles away from a knee specialized orthopedic surgeon. Ryan noted my apparent concern and began enacting 'knee gone bad' protocol. Stabilize knee – check, Vicodin – check, find surgeon.....not so easy. He and Dr Cristy Shank began making calls to the Union, the Division, the GC, searching out what options we had to get Ryan's locked knee operated on.

(Benson and Huddy brick climbing in front of the hospital)

(Corridor leading to the pediatric ward)

The next morning, still no firm plan in place, we headed to town, suitcase packed, prepared and hopeful for a flight for Ryan to South Africa. We sat at the Union offices, waiting for a ticket. At the last possible moment, a confident man swaggered in to find us and said, “follow me in my blue Merc (Mercedes)” so we did. He indicated with his blinker on the main street and we saw a man running at us, ticket in hand. Ryan lowered the glass in the window and accepted the papers. The drive to the airport was eerily quiet. Hudson fell asleep and Benson was at Lily's house so he was not making noise, at least not making noise in our car...I leaned over and whispered, “don't leave me alone here in Africa”. I don't know why that was my pressing thought, rather than, “good luck, and be safe”, but nonetheless I felt exposed, vulnerable, alone without Ryan in Malawi.

(The Operating Theatre and the swing door entrances to both theatres)

I received a text message from South Africa while eating with Kelvin and Sue Sawyer, “Babe, here's my Dr's details, google him and call me.” There was nothing alarming found from my search and Ryan decided he was comfortable with this Dr, so the next morning he had surgery. I can only imagine what his experience looked like, going into and coming out of surgery alone. Maybe on your 9^th knee surgery you don't need anybody around, but I would have liked to be there for my husband. He spent the next few days recovering and receiving some visitors and then flew home to Malawi.

(The outside of the "Annex", Malamulo's private ward)

(Inside the "Annex")

Ryan often quotes his Grandpa, “No problems a big problem IF money can fix it.” Certainly our health trials this month have reminded us of this fact. Just as Ryan was getting ready to 'hang up his crutches' and start bearing weight on his knee, I started to feel a slight tickle in my throat. “Oh man, a summer cold is brewing” I thought to myself. Then several days later, the 'summer cold' turned out to be a 'strange Malawian virus' that rendered me useless for over a week. It ripped through our ranks, with severe symptoms including headaches, lethargy, vomiting, diarrhea, muscle aches, fevers, laryngitis like throat, and general uselessness. As I lay on the couch trying to muster enough strength to chase after my 1 year old, I began to think “what ARE we doing here?”

(A typical scene coming up the hill from the hospital, these ladies and I were joking about my Mwana Galimoto - (baby car), my double stroller)

“Here” of course is Malamulo Hospital in Malawi. Malamulo is a 270 bed hospital by number but functions more at a 240 bed level. Elisa Brown (hospital CEO from the USA) speaks of the problems with supplies and suppliers for basic medications at the hospital, “finding money to buy medicines is always a struggle, and then finding a pharmacy in town that has stock of the medication is never routine or predictable.” This explains why Ryan has come home completely frustrated that there is no IBProfen, or even analgesic meds for post op patients at the Malamulo pharmacy. Elisa reports that Malamulo had 8,853 total admissions in 2010, 1,604 births and 327 major surgeries.

(Ryan amputated this man's pinky finger)

(Lady who has been suffering from a massive goiter on her neck)

(Picture of Hudson's Big Round Worm that was recently living in his colon - now he is fine)

(Benson woke up one morning with a swollen ear. It must have been from a bite, it gradually went away and now his ear is normal again!)

(Ryan looking a little worse for wear after getting this strange virus, and right - Ryan got a weird skin rash after swimming in the dam)

Ryan and I committed to serving the people and the hospital here because there is a genuine need for Doctors in Malawi. They estimate that there is one Doctor for every 60,000 persons. Malamulo Hospital is a mission hospital in a rural location. The covered walkways are lined with red brick arched details, the wide halls on the wards are trimmed with hardwood railings, circular windows add decorative flare to many of the wards, and the Operating Theater resembles something you might find in a regular hospital in America. Many of the patients that come through the doors have walked from a surrounding village. Since most villagers are unemployed, these patients have a hard time paying even 200 Kwacha ($1.30) for medicines at the hospital.

(Benson was wiped out for days, just laying on the couch with high fevers. Lots of snuggles from Mommy and Daddy made him feel better)

It's now rainy season (or Malaria season) and the corridors leading to the pediatric ward are lined with mothers and babies. Jacquie Cunningham, a volunteer Pediatric Nurse Practitioner from the United States tells me, “the wards are overflowing with sick children. Most have Malaria, but since even minimal hospital fees are too much for villagers , we only see the children when they are very badly ill.” The cost for a Malaria related hospital visit can range between 1,100 to 2,000 Kwacha, or between $6 - $12US. It's not just the ward that is bursting with sick kids. I mustered up the courage to take Hudson for his 1 yr vaccines and as we entered the 'vaccination' building we were greeted by hundreds of curious eyes. It was a moment when I was reminded that my skin is English white, and our hair so blonde. Part of me was grateful for “Mzungu” (white person) treatment which scooted us past the hundreds in the cue to the front of the line where a hospital tech was telling me, “we don't have the vaccines you need, we're out of polio, but we will combine this shot with that shot and you should be covered, please hold your baby's arm still.....” My gut wrenched and I did something I've never been that good at – listening to my instincts – I politely rejected the 'combination shot' and told them I was not comfortable with this regiment so I excused myself and we left. We are now in the process of hunting down the shots Huddy needs so we can be sure he is getting what is required in his normal vaccine schedule.

(Ryan, sporting his new and much loved battery operated head lamp, already used several times during power outages. Donated by Doug Benson)

Really there is nothing “normal” about health care here in Africa. Even a simple finger prick for a BF (blood film) to screen for Malaria makes me slightly uneasy. I find myself watching with eyes like an eagle as the technician opens a draw, prevents the draw from falling out of the socket and landing on the floor, and grabs a handful of needles. I am able to tune out the cries of my scared children to keep my focus on what the lab tech is doing. I am acutely aware of the presence of HIV and healthily scared of the disease to warrant my anal approach to anyone sticking my family with needles. As Benson watches them draw blood for my CBC, he promptly announces, “I'm NOT sick anymore”, and then when the lady asked “which one wants to go first”, he pointed to Hudson, “THAT one.” Now every time we walk to the hospital he first wants to know, “are we going for finger pricking or just to see Daddy?”

(Ryan - the general surgeon posing as an OB/GYN)

There are health insurance companies even here in Malawi. However, with unemployment ranging between 85-95%, the coverage is only for the elite. Many companies opt to pay on a cash system for their employees, while others use Masm or Momentum or similar insurance companies which might resemble something like the Humana or BCBS in America. However while Humana might negotiate provider rates for specific procedures, (which would be lower than a cash rate) here the hospital charges higher rates when you have health insurance.

Yesterday we sat across the table from the CEO of a large business in Blantyre. Ryan spoke about the medical developments Adventist Health in Malawi envisions. This man was intrigued and said, “I asked my wife if she wanted to leave Malawi because our healthcare is terrible here” he went on to explain that they travel to South Africa every 3-4 months for their check ups (as do many other business folk in town) and that health care is so important that they would consider leaving Malawi because of the lack of good care. There is a government hospital with a duly earned poor reputation, there are some private hospitals that have been performing sub-par, and then there are the Adventist Health options which have been improving and attempting to raise the standard of health care in Malawi.

(on a family safari at Majete Game park, just a 2 hr drive from Malamulo)

(we saw Elephants, Hippos, Water Buffalo, Water Buck, Impala, Nyala, monkeys, tortoise)

(Our family on our weekend away to Zomba Plateau with the Priesters)

(Benson and Huddy lending a hand in Ryan and Tiffany's chess game)

(Benson and Ryan at Chingwe's Hole on Zomba)

I am thankful every day for the questions that Benson dreams up. “Mommy, what are stars made of?” “Why do you have to shower in the morning and not at night like me and Huddy?” “Why does Daddy like the internet?” “Can Huddy and I open that blue packet in the pantry?” “Where is our shipment with my lego men?” “Where are Jesus and the angels we pray about every night?”

(Playing helicopter, helicopter 1 2 3, helicopter helicopter - FLY with me!)

Then there is my little Huddy Buddy who is now nodding and shaking his head in a desperate attempt to let me know that he understands everything! Today Benson informed me, “I think Huddy has poo-poo Mommy” so I asked Hudson, “Do you have poop?” and he locked his eyes on me and nodded emphatically with an excitement that oozed “you get it Mommy!” Hudson is quite selective about dishing out his kisses. Sometimes I ask, “Can Mommy have a kiss?” and he will either oblige and pucker up, or he will shake his head and motion as if to say, “you're out of luck Mommy, no kisses right now.” Huddy is starting to enjoy reading books on the couch, and especially likes the interactive ones, “That's not my Puppy” “Thomas the tank engine lift and look” “Henry the Horse” “Duck and Goose Feelings” and “Thomas songs” are all among the favorites.

(The Priesters and Ryan and B looking out from Queens View on Zomba. Our family at Chingwe's hole)

This is the stuff life is made of. My heart sings with joy when I listen to Benson conversing and watch Huddy communicating. So what could be more important than taking care of the people I love? Wherever you are right now, if you have access to good healthcare send up a praise to God! Good health is a treasure and a blessing. Maybe next time you drive to your Doctor's office, or take your child for their routine vaccinations you can think of Malawi and say a little prayer for this country.

(Benson on the first day with our three little kittens. The calico and the tabby reminded me of my childhood cats, so I purchased them from a villager who came to my door. A week later, my calico kitty was stolen - apparently people here LOVE cats! Every time our gardener sees the kittys venture out the gate he makes a dash and collects them and brings them back home. Bready loves to snuggle with the cats.)