Sunday Morning ~ Somewhere over the Atlantic

Ici n’chiani nkulinga mule awiri ~ You can ask what this is, provided there are two of you.

~ Chewa proverb

February 10, 2019

Hi Everyone,

It’s a long flight from Johannesburg to Atlanta, seventeen hours, so plenty of time to write, but I find it a little awkward. It’s easier with pen and paper than balance the laptop on this tray table with it being a bit bouncy. We’ll see how it goes.

Ursula and I spent a lot of time writing this week. She sat at the desk adjacent to mine and we hammered away at the policies and procedures we needed for the midwifery ward. It was a big job, but we got a draft done. It needs editing, augmenting, and referencing, but it’s a good start and something we were able to present at our meeting on Thursday. Interjected into the writing sessions were discussions about the issues we’ll be facing. For instance: What are we going to do if we’ve got fifteen women in labor and only two available beds? How are we going to manage a staffing problem if someone doesn’t show up for work? How will we implement ongoing quality improvement? Could we really do a staff retreat? What kind of renovations are absolutely needed for us to open? Who actually does the renovation? There are so many layers to this and we’ve only begun peeling them away. It’s exciting and daunting. 

There is an election this year in Malawi and there is an underlying uneasiness about the political future. I asked Ursula about her thoughts on Kamuzu, the man who was president for life during my Peace Corps years here. The couple who own the cottage I stayed in spoke highly of him, but others don’t. Ursula told me Kamuzu did a lot of good for the country. She said she benefitted tremendously from his policies, and the only reason she has her PhD is because of Kamuzu. I realized I didn’t know much about how she got her education. I knew she’d gone to university in the states, and I think I assumed she came from a privileged family. She was dean of the midwifery school when I arrived, an effective leader, and a role model for me. We are close in age. She explained how she got to where she is and how Kamuzu’s policies played a part.

She was born in a village in Kasungu, just north of Lilongwe, the third child of her parents. They lived so deep in the bush that she couldn’t go to school because of wild animal attacks. Leopards were so plentiful that the danger of them eating small schoolchildren walking miles back home at the end of the day was real. She said her father said he’d rather have living children than lose all in search of education. Only her eldest siblings went to school. They lived as subsistence farmers and were very poor. When she was ten years old, her mother needed to go to the hospital to have her seventh baby, and her father chose Ursula as the one to accompany her as guardian. She and her mother traveled together to the hospital and Ursula went to sleep with the other guardians in the shelter. In the morning a nurse called her to come and hold her baby brother. Ursula said she was so happy sitting and holding this infant, then looked up to see her father and siblings coming toward her crying. She asked why they were crying? They should be happy they had a new baby! Then her father told her that her mother had died while giving birth. They buried her mother and her father asked his sister to care for the baby. His sister told him she would take the baby, but she needed to keep Ursula also, to help her care for the infant. So Ursula stayed with her aunt as well. She told me, “That is when the family split.” A year later, the baby died of malaria, and after burying the last connection to her mother, Ursula started school for the first time. She did very well and when she had finished form two (which would be our sophomore year of high school) the president was starting Kamuzu academy to give Malawian children a chance for a quality education. At the time there were a few private schools but they were expensive and only white children and those from rich Malawian families could attend. Kamuzu Academy was meant to provide a quality education for Malawian students. They took two children from each district, a boy and a girl for each class. Ursula was the girl chosen from her district to start form three (junior year of high school). Some local nuns gave her the needed supplies: underwear, clothes, and other necessities. The uniforms and school supplies were provided at Kamuzu Academy for all students. She went and excelled. After graduating, she was supported by a group of Catholic sisters to go to the U.S. to attend nursing school. She got her nursing degree and masters in midwifery before returning to Malawi. Later she went back to the states to get her PhD.

I was speechless.

Know what I was doing when I was ten years old? Playing jumprope. Lying on a blanket in the back yard, listening to Red Sox games on a transistor radio. Sitting by my friend Beth’s pool reading Little House on the Prairie books. Skiing on winter Sundays.  Watching Wild Kingdom on T.V. on Saturday nights, fascinated by the animals and the African landscape. I was riveted, amazed at how they could film a lion take down a zebra, or a leopard feeding on an impala. I didn’t know the leopards were also eating children on their way home from school. Or that a ten year old girl somewhere on that continent sat holding her baby brother as her mother died in the next room.

I asked Ursula if I could share her story in my blog? She plans to write about her life and I don’t want to misrepresent any of it. But I told her this is such an incredible illustration of how risky childbirth is in this country, how young girls have to care for younger siblings, and how random the opportunity for education is. At home, we take all this for granted. When I showed her what I’d written, she had to clarify some of it, and I realized I missed some details as I listened to her story. I was imagining being that ten year old girl holding the baby. I hadn’t heard whether it was a boy or girl. I thought of how lonely and frightened I might be, sleeping in that guardian shelter with strangers. I thought of my own mother going to the hospital when I was ten for back surgery. I hated that she was gone for several weeks. I remember my father dropping us at church and realizing before I walked in that I wasn’t wearing a hat. I didn’t know what to do. My brother told me I couldn’t go in, but I couldn’t stand outside. My father had already driven away so I had no choice but to go in. I went to one of the nuns and told her my mother was in the hospital and I didn’t have a hat. I asked her what I should do? She took a tissue out of her pocket, folded it in thirds, took a bobbie pin off her veil, and pinned the tissue to my hair. She told me to go kneel down and pray. I did, for my mother. I left the tissue on my head until my brother and I had walked all the way home. I had always thought of that as a traumatic childhood experience. When we went to visit my mother in the hospital that afternoon  the first thing I told her was about the hat. She laughed and then it didn’t seem so serious. I can’t imagine if we’d gotten to the hospital and they’d told me she was gone. 

There were so many moments that made me hopeful and optimistic this past week. We had our big meeting Thursday morning with the country director for SEED Global Health, the administration for the nursing school, faculty members, and the chief nursing officer from the hospital maternity department. There were a few conflicting meetings so some of the key players were missing, but it was still really productive.  Some days I’m overly optimistic about what this ward will accomplish: we’ll set a new standard of care for women, we’ll bring down maternal mortality, we’ll turn out superior students, etc. etc. etc., and other days I’m thinking this is never going to happen. I’m afraid to let the latter thought take form as I don’t want it to be a self-fulfilling prophesy. When we all sit down together and I hear people supporting it and coming up with ideas of how to make it happen, it fills me with energy. This is what I want to be doing right now. I so believe in this. Ursula gave a short history of the project and I gave a report of progress to date. These things made me feel like we’ve come a long way in a relatively short amount of time. But when we begin discussing next steps I start thinking, “Holy smokes. This is huge. How are we going to do this?” and then I start fantasizing about a donor just handing us zillions of dollars to do whatever we want, then I reel that one in and start imagining going door to door asking for some Kelly clamps, emesis basins, and an autoclave. Nothing I hate more than asking for money. I still have PTSD from doing that for the Women’s Health Center, though, I’ve got to say, it seems easier in Malawi than in the states. People ask for things all the time there and it doesn’t have the same stigma I attach to it here. 

The architect students sent a floor plan they designed and Ursula and I looked it over before the conference call with them to discuss it. It is gorgeous. It is a dream. I wanted to live on this drawing. One of those movie scenes played in my head where the whole fantasy rolls out in technicolor with dreamy lighting where smiling mothers were holding perfectly delivered babies. Guardians chatted with each other in an airy garden and midwives floated between beds offering massages and support. Students washed their hands in a clean sink with water that actually came out of the faucet. And soap. There was soap. The maids did their jobs between a dirty AND clean utility room. Oh, it was so beautiful. All the while a gentle breeze blew through the open windows providing natural light. At night, the solar energy provided light when and where we needed it. Staffing wasn’t a problem! Midwives begged to work there! No one called in sick, and if they did, no one minded working a double shift. Oh it was heaven. Then the little ding signaled that the email had come and I woke up and we connected to the Zoom meeting in Philadelphia. I’ve gotta say, that is a cool technology that zoom. We could be part of the class and we could ask and answer questions. It was amazing! I was sure the internet would be too slow for it to work, but see? If that worked, there’s no reason we won’t get this ward established. We might have to start with something a little less dreamy than the drawing we reviewed, though. At this point the running water would make me happy. At the end of this month we’ll have five different drawings to use as we wish, and it’s another step in the process. We’ve got our lists of things to accomplished and it looks like I’ll go back in June. We’ve got a target to open on October 1 of this year but a lot has to happen before then. 

On top of all that, I met with the women’s group on Monday. One of the women lives near my old house and I went with her to the village where they now meet. I would never have found this place by myself. There are eight women who still meet twice a week and I was bowled over by the mountain of jewelry they’ve made. The quality has improved a lot and they’ve come up with some new designs. I was thrilled to see this. I asked where they were selling it, and they told me they aren’t. They are just making it. Ok, seems they need some help with that. They told me that Rachael, the woman I’d left it all to, hasn’t come since last August or September. And the guy from Catholic Relief Services, who was supposed to teach them some business skills, didn’t show either. And Chimemwe, who was supposed to be their teacher, got hit by a car a month after I left and has a debilitating brain injury. Given all that, I was so proud of them for still meeting! And making cool stuff! They have hired another man from the village to teach them to make the wire designs. He was there working on some bracelets. I asked if he were teaching them or just doing it himself? They said he was teaching them. Ok, great. It seems there has been some confusion about what to do with money and buying supplies, much of which I didn’t understand, and knew I would not be able to sort that out. I only had a short time with them. I love some of the new stuff they’ve made, though, and bought some and told them I’d order more to pick up when I come back. Irene, the woman emerging as a leader of the group, explained this to them and took note of some quality issues I pointed out. I explained that to sell these they have to be really good quality. I told them about the farmers market on the first Saturday of the month, but that will require paying for a table and I think they’ll need some help getting that set up. I decided to try to find the guy who’d agreed to help them. I also sent several messages to Rachael to find out what the hell happened to her. Then Irene took me to see Chimemwe in his village. 

George had seen Chimemwe right after his accident when he was just regaining consciousness. George said he left weeping. I was preparing myself for what I was about to see, but I was blown away by how much progress he’s made in his recovery! He is walking without help, a little unsteady, but he says that’s because he can’t see. His vision comes and goes. His language was perfect though and his mind sharp. For that I was so incredibly grateful. I asked if he notices improvement with his vision over time and he said he does, but it is slow. He’s frustrated that it is taking so long. I said, “It’s only been six months! Six months ago no one was sure if you’d survive!”  He said six months seems like a very long time and he wants to go back to work. His father, a very well spoken gentleman, came to greet me. His English is perfect and he said, “Your husband told us you would come, and now you have.” We chatted awhile and as he left he told me they are all very grateful to George who left them a good amount of money to live on until (hopefully) Chimemwe could work again; he was the family support. Before I left I gave Chimemwe some money and tried to be reassuring. I told him he still has a lot to offer and maybe he could teach the women a little English until his sight improves. That didn’t go over too well.

On Wednesday I went over to the Catholic Relief Services office to find the guy, David, who was supposed to meet with the women and didn’t. I wish I’d had a camera in my hand when he opened his office door. That was a classic. You’d have thought I was Jacob Marley. He actually screamed when he saw me. Then we both started laughing. To his considerable credit, he took total responsibility. I asked if there was confusion on the women’s part? He said, no, it was him. He just never went. I appreciated him being honest. He said he commits to too many things (I can relate) and was very sorry. I told him about my visit with the women and asked if he knew of any business courses or anyone else that could help them. I’d be willing to pay for Irene to do a short business course. He said, “No. You have inspired me. I will do this. I will make good on my promise and make a plan to meet with them.” I told him about Irene and how it would be best to go directly to her. He told me he’d meet with her on Friday and make a plan with her to meet the women. And he did. So that was a success.

I never did meet up with Rachael though. I’ll track her down the next time. 

Whew. This is getting long so I think I will wrap it up. I’ll be too tired to drive home when I land in Boston, so will probably just vegetate on the couch at my daughter’s, hug my grand babies, and drive home early Monday. 

Love to all,

Linda