March 2000

Dear Friends and Family

The last months have flown. I've been hoping for time to reflect and process so this letter could be organized, but no such time was forthcoming.

Our staffing reached crisis levels as the holidays approached. I was the only doctor instead of being one of three. The clinical officer sent from a sister hospital to help became a patient himself requiring lots of care before we sent him back by ambulance to a surgeon. (He has recovered.) Our nurses began what has become a long series of seven-to-seven shifts. They are alone on each ward without a nurse to relieve them for breaks or lunch. Malawi's worsening nursing shortage is hitting us hard. The nursing council raised the requirements for nursing school at the same time the ranks are being decimated by AIDS. We tried to each work harder, but one good nurse cannot accomplish what two good nurses can, and I certainly couldn't do the work of three doctors.

We were also grieving Miriam Kaunda, the beloved wife of our accountant Save Kaunda, who developed an overwhelming pneumonia and died within days. (This was my first time to be called to pronounced such a good friend dead. I so much wanted to shake her to somehow wake her up.) Next, our dear nurse, Fellen Ngulube, became almost constantly delirious. She spent her last few weeks in and out of the hospital. Mostly she mumbled, but she clearly and loudly stated, "Doctor, I'm dying" each time she saw me. We pray she is now united in heaven with her husband and two children. Sadness seemed to be spreading at the same time we were preparing to celebrate Christmas.

The biggest preparation at the hospital is practicing for the Christmas drama. The actors are all hospital employees. The costumes are mainly made from blankets, scrubs and bandages. The stage is the space in front of the chapel. Patients, guardians, staff, and other folks start seating themselves on the lawn and on benches and chairs long before the curtains open. The smiles, laughter and gratitude expressed by the audience is contagious, and the joy of the season spreads.

I remember being struck by how Jesus surely understood the predicament of our poor moms and babies. Jesus was born to a prima gravida without a doctor, a midwife, traditional birth attendant or "ngogo" (older female relative) to assist! Our staff drama gives the innkeeper's wife a prominent role in helping Joseph and Mary, finding the thought of them delivering Jesus without assistance unbearable. I was also struck that the angels first brought the news of great joy to homeless men who worked and slept in shifts. Their fatigue did not block them from receiving "great joy," and it would not stop us either.

A Christmas party followed the drama, which included singing, speeches, dinner, and everyone receiving a gift to match the number they selected from a plastic bag upon entering the chapel for the party. The gifts are donated or collected throughout the year. The big winners are those who receive the plastic trunks that hold other presents, for these "action packers" are lockable, light-weight, and close tight so ants and rants don't crawl inside.

Next, New Year's was upon us. We didn't have any Y2K scares, as most of the technology that people feared would be affected has never arrived in Embangweni. By the time the day arrived, I was into my second week of constant on-call, and feeling each day I had done enough if rounds were finished and emergencies attended to. So, Revelations 2:2–5—"I know all about you: how hard you work and how much you put up with. . . I have this complaint to make; you have less love now than you used to"—felt like a blow in the face, and repenting this lessening of love became my New Year's resolution.

Thankfully, by mid-January, we had the short-term help of Drs. Ernie Brown and Bill Beltz. Then in February, Dr. Paul Jewett returned to fill in so I could attend the Christian Medical and Dental Society conference in Kenya. Paul also killed a black mamba in my house a I bravely jumped onto the furniture, hysterically pointing to where the snake was hiding. In a few more weeks, we will be back to three doctors, and I will be able to return the in-charge role to Dr. Neil Kennedy.

Many days the duties seem too much, and then I listen to our patients who persevere. We have a family admitted to children's ward. They have had three sets of twins, and named the last set Pilirani and Tilije ("Keep Calm" and "We have nothing"). Of the seven-year-olds, the oldest set, one is dead and one is on male ward with kwashiorkor (severe malnutrition in infants and children
caused by a diet high in carbohydrate and low in protein). Of the second set, one we have sent the grandmother to get from home because the second is here with kwashiorkor. The third set both have marasmus (chronic undernourishment caused by lack of calories and proteins). We don't usually admit whole families, but sending them back before harvest would be cruel.

We almost daily admit young folks for tuberculosis treatment who also have AIDS. Our adult T.B. treatment includes one to two months of inpatient treatment with streptomycin. So, we are able to watch many go through the stages of grief, and sometimes help them grieve. We have a fellow now who has found peace in the last week, and will soon lead the chapel service that starts our work day when "my turn" comes later this month.

Thank you for your prayers, support, and love.

Have holy Lent and happy Easter.

Martha Sommers