Chapter Three – The Work Begins - Hospice of the North Coast

Chapter Three: The Work Begins

The need for medical care in Malawi is intense. Overpowering. Painful to witness and, at times, almost too much to bear.

Just one day into their journey, the HNC team encountered a malnourished baby (a twin). The mother had trudged with both infants on foot over the 15 long, dusty miles to Nkhoma Hospital to obtain soy, only to find that the nutrition clinic was closed due to a holiday. In contrast with typically impatient Americans, the mother stoically accepted the dilemma and resigned herself with a sigh to start the long walk home. Fortunately, help was at hand. Shelly recounted, “We were heartened to go along for the ride as hospital staff obtained nourishment for the child and transported the family back to their village via ambulance.”

Through being a part of situations such as this, the foursome quickly recognized that in the face of harsh challenges, one can choose to be either overwhelmed, or energized. Shelly, Sharon, Cyndie and Cristina chose the latter response and were busy day and night doing everything they could to observe and support their Global Partners in their brief time in Malawi.

Sharon said, “We watched Nkhoma professionals address the need wherever it was; whether patients came to the hospital or the palliative care team members reached out to them in their villages. Often, villagers would gather around us when they realized they had American visitors. The children always wanted to be photographed full of smiles and to see the pictures. We were happy to take the time to oblige. Here as in America, children are our future.”

Respecting Traditions and Values

Having meticulously done their homework on the country’s culture and customs before leaving the U.S., HNC team members were circumspect in their approach; making sure that everything from their apparel to their behavior and words reflected a respect for Malawians’ values and way of life.

They confided, “We rigorously avoided projecting or imposing western concepts of ‘here’s what you should do’ and instead were intent on observing, asking questions, listening with our ears and our hearts; educating ourselves on what we could do in the future in terms of partnering and mentorship programs.” Cristina remarked, “I took note of gaps that I now am looking to bridge in ways that can benefit the spiritual aspects of palliative care.”

The team also offered on-the-spot innovative solutions. Sharon described one such homespun response to a sadly not uncommon issue. “The clinicians lacked a measuring tape to obtain a baseline measurement of a patient’s swollen belly caused by liver cirrhosis and thus could not ascertain if the ascites was worsening over time. I said, ‘How about if we use a piece of rope to encircle the belly, then tie a knot at the baseline measurement. The next time the patient is seen, tie a knot at the new measurement.’ The clinicians smiled at the practicality of using everyday items to help them in their work. And it worked!”

Heartbreaking. Heartening. Hopeful.

Day three began with the team attending to a severely ill patient who had traveled nearly 20 miles over bumpy, primitive roads via bouncing oxcart to be treated at Nkhoma Hospital’s outpatient palliative unit. The day continued with the team traveling to villages.

In one locale, four patients and their families gathered on a bamboo mat rolled out to cover the dirt and clay. Cyndie recalled, “They greeted us with such gratitude that we would come this far to help their loved ones. Their appreciation buoyed us up.”

On this and other days, the clinicians worked unstintingly – sometimes on the fly – to address unforeseen challenges and crises. Sharon explained, “We visited a man with Stage 4 HIV who had suffered a stroke that caused left-sided paralysis. Unable to walk, he scooted in the dirt to maneuver from place to place. His living quarters consist of a four-foot-diameter circular mud hut. He was sleeping on the hard ground. In response to this dramatic need, we traveled quickly back to Nkhoma, where we purchased a mattress and blanket that we delivered to the appreciative patient the very same day.”

Cristina worked with chaplains in the villages to offer spiritual support. “I was honored,” she said, “to deliver a sermon to staff and to bless a young student while her ill grandmother was seen by clinicians.”

An Attitude of Simple Gratitude

Lest anyone think the journey was one of gloom and doom, the four-person team was quick to assure that it was a privilege to be welcomed by the warm Malawian people and to work with the palliative care professionals at Nkhoma Hospital.

“We learned so much from the patience, resiliency, resourcefulness and positivity of the people we met. They touched our hearts,” they agreed.

“The word ‘complain’ is not in their vocabulary. We will carry their attitude of simple gratitude with us as we move forward to the next steps of our Global Partnership.”

Most of all, they say, the trip has taught them, “We are all really in this life together. Whether it is reaching out, one human to another, to relieve pain, or the simple but profound pleasure of presenting children with soccer balls and watching kids at play, we are the world, and the world is us.”

As they bid goodbye to Nkhoma Hospital staff and the community, that world became a better place. The geographical distance between Malawi and Carlsbad melted in a sea of goodwill as Dr. Sam told the homeward-bound travelers, “You wrote history in our palliative care programme. The smiles left miles of happiness to our patients and us as a team.”

Now, it was time to journey back to North County San Diego and champion the Global Partnership cause.