Sunday Morning~ Progress

Sunday Morning ~  Blantyre

Musamaumirire mtunda wopanda madzi.~ Do not keep on staying in an area without water.

~ Chewa Proverb

March 4, 2018

Hi Everyone,

If there is no progress, change your plans. Not to be confused with ‘’give up”, this is the attitude we had going into this week’s meeting about the model ward. If we can’t get it going at QECH we’ll change our plan and do it in a different location. I am starting to feel like my time here is very short. What have I got left, four months? A little less? And a few of those weeks I’ll be away. It’s nothing. This week I had to shift my mental image to what might realistically be accomplished by the time I go and I know there isn’t going to be a functioning model ward by then. That said, Thursday’s meeting was very encouraging. My colleague, Alice, said, “I think we are at the base of a very high mountain. It will take some time to reach the top.”  My feeling was more like I was swimming and suddenly found myself way over my head. Not like I’m going to drown, because I’m still swimming, but want to be aware of how deep it is, where I am, and how far from shore.

We were supposed to go away this weekend. It’s a holiday weekend, Martyrs Day, so Monday is free. We had booked a place at the lake called The Blue Zebra, a luxury lodge with a rainy season/resident special rate and thought we’d tick another one off our list. But at 2:30 Friday morning we were awoken by our guards yelling for George. I was dead asleep and thought he was having a nightmare and trying to get out of bed. He yelled to me, “Something’s happened! They are calling me!” I was having a hard time waking up, confused, not scared, even though the likelihood was that someone was breaking in. Then I saw headlights and George came running back into the bedroom and said, “The Scots have been robbed!” By this time I was trying to get some clothes on and went out into the living room where our friends from UK (George’s colleagues) were standing with the police. One of them, dear Ruth, was leaning on an umbrella for support.  I said, “Let me make some tea.” (I learned something from all those Call the Midwife episodes. Everything British is treated with tea: robberies, illness, death, you name it.) But they didn’t want any. They’d already had tea. The robbery was over an hour old and they’d been sitting with the police at their house going over everything. They’d come to us to get a phone as all theirs had been stolen.  Their house is next to the one we used to live in. We’d been forced to move from there as Peace Corps deemed it not secure enough. Well, there you go. There is no wall around those houses. They are owned by the College of Medicine and there have been plans for a wall, but you know how that goes. The two night guards had been tied up, (they never yelled or screamed) the six robbers broke a window in the porch door and used a crowbar to pry it open. (George maintains that since we had a padlock on the inside grate they wouldn’t have gotten in if we’d still lived there.)  George gave them his phone and they left to go finish giving a police report. They didn’t want us to go with them, apologizing all over the place for disturbing us. We didn’t get back to sleep. We stayed up and talked for a long time and didn’t feel right going away for the weekend. We planned to walk over there as soon as it was light to see what they needed and what we should do.

George went over first while I baked some cinnamon rolls to take over. I figured comfort food would be good, sweet and buttery. The other team members were there when I arrived and we did a little debriefing. Ruth, who is the sweetest woman on the planet, said, “Oh, now see? If this hadn’t happened we wouldn’t be eating these delicious cinnamon rolls!” Nothing like looking on the bright side.  Lost wallet, laptop, phone, and sense of security, but hey, she got a cinnamon roll out of it. What a wonderful world this would be if everyone were like her.

They are all ok. They moved out of that house and are settled into a lodge. We had them to dinner last night and they’ve done a good job of processing it all. They are all psychiatrists so are used to dealing with trauma, but still. It all could have been a lot worse.  We don’t feel unsafe in our house (we didn’t in the other one either) as it has a brick wall around it with razor wire, not that a wall would keep a Malawian out; they can climb a wall like it was flat, and even the razor wire is only a slight deterrent. It just buys some time. But we have panic buttons in all the rooms and the guards have one too. There is a lot of speculation that the robbery was an inside job; that the guards were in on it, that’s why they didn’t yell. Who knows. At home they could have been armed with assault weapons. The U.S. is still a scarier place to be. It’s interesting how things can change so quickly. I went to bed Thursday all happy about how the model ward meeting went, feeling optimistic about the future, and looking forward to our romantic weekend in the executive bungalow on the water. It’s probably the reason I was sleeping so soundly. Instead we are having a peaceful weekend at home, grateful for the friends we’ve made and glad they are safe and resilient.

The meeting had been a raging success. By that I mean this model ward is really going to happen. The reality of the effort it will take, however, is sobering. But, considering it will be a shift in the entire system, it’s understandable it won’t happen overnight. I remind myself it took ten years for us to get a new building for the Women’s Health Center in Bar Harbor. Ten years after everyone agreed that a larger space was needed. So, again, no one should be pointing fingers at the pace of progress around here. I’m still amazed we can get everyone in the same room to meet for a few hours in the middle of the week. That alone seems like a success to me.

Attendees showed up for the 8:30 a.m. meeting at 9:15. I had cleared my schedule this time, knowing it would take longer than expected, so I wasn’t stressed about this. While waiting we strategized about the agenda. We had agreed that Ursula would facilitate even though I had written the agenda and sent out the invitations. I agreed to take notes and write up minutes. I was thrilled that Alice, a colleague who had been a bit skeptical of the extra work this would entail, agreed to come as well. I had bought tea, milk, and sugar and baked a banana cake. When everyone arrived, the meeting began with a prayer, then Ursula asked me to give a history of the proposal and an overview of how it stood presently. We had invited all the head nurses (they are called sisters-in-charge here), the head of all the matrons (equivalent to the VP of nursing/midwifery), the head of the OB department who was at the last meeting, and the head of OB at the College of Medicine. The two doctors came in saying they only had a few minutes to spare as they had other meetings to attend, then both stayed for two hours.

The consensus is that this is a brilliant idea but questions remain about how to create the space and staff it. All of this we were aware of already. The College of Medicine doctor pointed out that they are required to do some staffing at the hospital and there is some resentment that the nursing faculty don’t do that. Ursula, who is my heroine, is mind bogglingly good at diplomacy. She calmly waited until the speaker was finished and replied with,”That is true but is a bit unfair. The College of Medicine is only 26 years old. When it was created there were no obstetricians in the country and QECH relied on them as consultants. Your infrastructure was created that way, ours wasn’t. We are trying to emulate that but we don’t have a system to do so. That is what we are trying to do with this project.”  Everyone saw her point. I nearly wept. I have so much to learn from her. We’re making progress, have another meeting scheduled, and have tasks assigned to be completed before then. We’ve got the major players on board and the plan to move forward was made together. This feels very big and grown up, and also slightly over my head. Part of me wants to stay here and see this through, another part wants to go home and work on getting services to rural women in Maine. I don’t know.

My first year students start their first clinical experience on Tuesday and need to be there at 7:30 a.m. in uniform ready to go. We have been practicing skills with them this past week. Anytime the students are in the skills lab, uniforms are required so they’ve been wearing them all week. Thursday they asked if they could wear street clothes. I was going to be reviewing documentation with them in the classroom, so said, “Sure. Fine with me.”  After my morning meeting I got to class and gave them some scenarios to write up as if they were documenting in someone’s medical record. Then we began reviewing what they had written. About an hour into class, the students looked out the window and someone said something in Chichewa and half of the students got up and ran out. Mass exodus. I was stunned. I asked the others, “Where are they going? What happened?” One girl answered, “It is going to rain madam. We have washed our uniforms and they are drying outside.”

I love these kids.

Love to all,


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