Sunday Morning ~ Little by Little

Pang’ono-pang’ono ndi mtolo. ~ A bundle is gathered stick by stick, little by little.

~ Chewa proverb

November 14, 2021

Hi Everyone,

I’m the first to admit I’m impatient. I used to allow a week or even two before getting agitated waiting for a response to a written correspondence. It made mail delivery an event, like being handed a gift. Now, if I don’t hear back in a day I’m on edge. This has made creating sustainable accomplishments frustrating with expecting results in an unfeasible timeframe. The media exacerbates my impatience so this proverb is a good reminder. Itcomforts me. If making the bundle involves people of varying viewpoints and tendencies, well, accomplishments can take awhile. This week I received the news that the midwifery ward first put forth four years ago by the wise and wonderful Ursula Kafulafula, dean of the midwifery school, became a reality. It was something we thought might take a few months, then maybe a year, then God forbid, maybe two. It was the reason I extended my contract as I was so excited about working on this project. It hadn’t happened when my time was up the first go-round but surely it would be up and running by the end of the second year! Well, I have a lot to learn from those who don’t give up. 

From the minute Ursula described her dream of having a ward at the teaching hospital run solely by midwives where women without complications could get care, where we could model respectful care to student midwives, and demonstrate, with hard data, how many fewer complications and healthier outcomes resulted, I was self-appointed cheerleader. This had been my pipe dream for teaching hospitals here where women could choose midwifery care and receive that care in a designated ward apart from the invasive technology rampant in the high risk wards. We are all well aware of how low risk women become high risk when they are part of that milieu. In Malawi, step by step, stick by stick, it went from a casual conversation in a car ride to Lilongwe, as we aired complaints about the student experience on the wards, to the opening of the first ward fully led by midwives. Well, first in this day and age. It used to be all the maternity wards in Malawi were run by midwives. Just like here, it used to be all maternity care was delivered by midwives. Now, it’s innovation. What a circle.

A global pandemic was not something we foresaw or factored in. The original space we had been given was perfect. It was close to the school of midwifery so faculty could conveniently walk over for teaching and supervision. It was large enough to expand once established, and proximity to the high risk ward meant a woman could be easily transferred if needed. When the pandemic took hold, the midwifery ward space was transformed into a Covid ward and another space was acquired about five miles away. I was disappointed to learn of the location, but happy the project wasn’t dropped altogether, and this past week I learned via WhatsApp message from Ursula that the ward had opened with great fanfare. There were chitenjes made for the event: a circular logo with the words *Transforming Maternity Care in Malawi * Midwives Leading the Way* around a simple image of a midwife holding a baby. It’s amazing. The Minister of Health gave a speech. The current dean Elizabeth Chodzaza gave a speech. The video sends us walking through the ward with functioning sinks, showers, air circulation, clean beds, and mosquito nets. This can be a model for maternity care everywhere. The ripple effect can be fantastic. I’m so happy it finally happened and so sad to not be there to see it.

All this was on my mind at church as I listened to the priest, who originates from Cameroon, give his thoughtful sermon. I wondered what he thought of us. The music in our tiny church on the ocean is weak at best. We have an organist whom I admire; she’s been playing music for decades and is now well into her 90’s, but the congregation mumbles through the songs, the octave too high for all but one or two parishioners, and it sounds pathetic. I thought of masses in the African countries where I’ve lived or visited and chuckled. They are veritable rock concerts. The congregation belts out their love for the Lord from the depths of their beings. There is dancing and whooping shaking the rafters. I wondered how they convinced priests to come to our dwindling parishes. Was he wondering if there was any hope? Did we all sound like we were giving our dying gasp of faith? How ironic, I thought, that he would be here as a missionary trying to save us. 

At our social time after mass I asked him what he thought of the difference between mass here and those in Cameroon. I told him I’d lived in Malawi and Congo and I find our masses rather anemic comparatively. I told him I’ve not been to Cameroon so was generalizing, but wondered what his impressions were. He was ever so polite and dignified and said, “Ah, we go through an orientation before we come so it won’t be so much of a shock.” I laughed. It was the most delicious cultural exchange I’d had in two years. 

I thought of the midwifery ward and how progressive and healthy it will be, how amazing it would be to do the same here, but how much harder it will be to move the concept through our system. Despite reams of evidence supporting the benefits, our health care system cares deeply about control and money. If I take the long view, impatience be silent, it might be something to work toward.

On election day I collected signatures for a citizens’ initiative to get a universal health care resolve on the 2022 ballot in Maine. This would require the Maine legislature to implement a publicly funded health care system for Maine residents by 2024. It is a brilliant strategy to approach universal health care with a mandate. Twelve hours at the polls convinced me there is enthusiasm for this. It was not a hard sell. Most people lunged at the petition to sign. They were desperate to get some kind of understandable, universal system that covers them when they need care. I had to deliver the explanation in a few short sentences to keep the line moving. Some waved me off but they were the vast minority. People from all walks of life were eager to sign from construction crews to lawyers. One retired physician enthusiastically cheered when I explained the petition which triggered one of the poll workers to come sign when there was a lull. She told me it was his response that made her believe this could be possible. 

Our actions make a difference, little by little. 

Love to all,

Linda