Winding down

Tomorrow we get on the plane for the long trip back home.... we are not looking forward to the plane ride, but we are ready to be back home. Yesterday was spent wrapping up last minute details - and of course, we did not get everything done. This IS Malawi, and everything takes twice as long as you think it will take / should take. We leave most of our clothes, plus tons of other things (printers, ice chest, tools, medical stuff, etc etc) here, so we don't haul it all back and forth. The Magaffees have graciously allowed us to use their storeroom until we return.

I want to take this opportunity to introduce you all to some of the guys we interact with daily. Mr. Whiskas (I think the official spelling is Wiskesi) is an old friend who has been our housekeeper every time we stay at the Assembly of God guest house. He is in his mid-70s and officially retired last year. He came out of retirement to work for us and we were delighted to have him. He is energetic and hard working. He and his wife live in a nearby village, Mslitsa, and he bicycles in to work every morning. He had asked that we bring him some barber shears when we came this time (we did) and he used the money he made working for us to build himself a barber shop attached to his house. He is going to embark on a new career: a barber! What a guy! He thinks he will be open for business by mid-Sept. I wish I could be here for the 'ribbon cutting'. Of course, he hasn't actually learned how to cut hair, yet, but how hard can it be? The folks here (men and women) usually just shave their heads. We went to visit him yesterday to see the shop and then bring them both over for dinner. They are very special people and we are thankful God has put them in our lives.

At the guest house, we have a day guard / gate opener / gardener and night guards. The day guard is usually Sampson, a charming, handsome young man whose favorite phrase is 'Thank You'. He is delightful but I am not sure we communicate very well with him! He lives in the same village as Mr. Whiskas and bikes in to work also. He is single but lives with his younger brother. We gave him a pair of Joseph's sunglasses and a Frisbee. I think he knows how to play with the Frisbee, although 'play' is not something they do very often here. He has this funny little wave that we love to see - something he does with a couple of his fingers...

Our night guards are David and Moses. David lives in another village and bikes in (see a trend here?), is married and has three children. He listens to Christian radio at night, reading his Bible and studying God's word. He was sick earlier in the trip and we were thankful that we had some medications to give him - he is recovered now and feeling 'powerful' again. Moses is the other night guard. He went to the same language school as Sampson ('Thank you, thank you madame').. he is always smiling. He is married with 4 children - and bikes to work! We gave our night guards items for their children, wives and a little something for themselves.

We are always happy to stay at the AG guest house. The AG missionaries are awesome folks, the house is well kept, and we love the workers here!

Today we finish packing, have lunch with the Spencer's, pay our clinic 'bill', and do any last minute things that need to be done before we head for the airport in the morning. If you have followed this blog, I hope you have enjoyed it, that you have learned something about Malawi and her wonderful people, and that you have taken time to pray for the people here - nationals and workers of all sorts that are here.

Thanksgiving / Praise: a productive, safe trip; all of our friends here; all our supporters back home.

Prayer: safety these last few days and travel safety on the trip home; all the folks we are leaving here to carry on / endure.

Pictures:

Joseph and Moses

The Whiskas' and Joseph at dinner - note the large bottles of Sobo (orange crush, a favorite drink here) - no Cokes! The country is in the midst of a coke /coke product shortage - go figure??

The Whiskas in front of the almost finished new barber shop

Joseph inside the shop (to give you some perspective on the size)

Joseph and Sampson with his Frisbee and sunglasses

David at the gate

Kamuzu Central Hospital and the Prison

Monday we (Joseph, Carson and I) went to Kamuzu Central Hospital (KCH), the big government hospital here in Lilongwe. Our plan was to volunteer in the Casualty Department (ER for us Americans). We had visited with the doctor over the ED and surgery, Dr. Muyco, earlier in our trip and he was agreeable to this plan. However, he was not around Monday, so we found the charge nurse to get clearance. It is strange how people can just show up, say they know Dr. Muyco, and start 'working' in the ER. I was paired with an intern, Dr. Elaim Banda. I think I may have made him a little nervous at first, but we got along fine. He was a smart guy and I enjoyed comparing notes, how differently we treat problems in Malawi versus the US, etc. Of course, not only do we (US doctors) have the diagnostic tools to help us, but we also have basic supplies, many of which they did NOT have at KCH. Joseph and Carson were also in the triage 'room' (actually a big room with 4 stretchers) - the patient starts out in triage and then is examined and a plan formulated - admit, refer for further testing, refer for an appointment with another area (i.e. surgery, etc.) or a procedure. We saw hypersplenism in a couple of patients, a ventral hernia, hypogonadism in a young male, a couple of RTA (road traffic accidents) - one that morning and two from earlier in the month with continuing problems. I saw some patients on my own; Dr. Banda picked out patients or their families / guardians that spoke English. Joseph and Carson sutured a facial laceration that extended through the vermilion border and helped me with an incision and drainage of a big, big abscess on a child's head. We also saw a poor guy with HIV who had a 'spot' cut out of his leg - now his entire leg was swollen and the 'spot' had grown and was bleeding. I cannot attempt to describe the way this tumor looked or smelled, but it was obviously Kaposi's sarcoma and it was a huge, fungating, expanding, foul smelling, bleeding mass. He was in distress from the swelling and the pain. In the US, he would have been admitted, maybe even the ICU - here, he was sent home to return to the general surgery clinic (excuse me, but what on earth are they going to do with him???). To look into his eyes.... he was truly a dead man walking and he knew it. I admire Dr. Banda and the other doctors there who do this impossibly difficult job day after day. We also saw a young boy with a mass growing out of his head - it looked like a little brain on a stem. Very weird... Dr. Banda had never seen anything like it (neither have I)... he got referred to the general surgery clinic, too, for evaluation and removal. The good news - they had film for the xray machines (apparently had been out of film for a couple of months), the bad news - no gauze, no tetanus shots, and very little small suture material. They brought out some HUGE suture material for the facial laceration. We stayed and 'helped' (although you wonder how much help you really are, fortunately Carson had rotated through there before so knew some of the protocols) until lunch time.

Monday evening, the Maseko clan - at least some of them - came to Lilongwe to drop Mebble off to fly back to the states. We all met up at the Pizza Inn, had dinner and a nice visit. Pizza Inn has pretty good pizzas, and a nice play area for the kids!

Today (Tuesday) we planned a clinic in the prison. We didn't get started as early as we would like, as our translators had to register for college classes. It was different in that there were only 4 of us - like when we first started these village clinics! I had Esnart as my translator, Joseph was the pharmacist with Charles as the translator. Joseph was trying to keep track, he thinks we saw ~150 patients. The prison here is so depressing. The men's cells are meant to house 60 - they currently have 200 in each cell. You apparently can be put in the prison for long periods of time, waiting for your case to come up for trial. Most of the folks here cannot afford a lawyer, so their wait can be long, You get 2-3 meals a day, porridge for breakfast, then nsima (cooked maize flour) and beans for the other meals. They have a clinic with a clinical officer who is there some days, but there is no medicine (the government is apparently running low on funds and meds, and the prison is at the bottom of the list). There is an VCT nurse who supplies ARVs (antiretroviral medications) for the HIV patients, but it is questionable if they actually get the medications on time. Also, if they test positive for HIV, then they have to have a CD4 count - another delay in their treatment. No one seems in much of a hurry to get these folks on treatment. They have a way to test for TB, but the lab tech has been on holiday, and KCH has been out of films for xrays, so who knows how many of those coughs I saw today were actually TB? I saw more cases of scabies - horrible, total body involvement scabies, than I have ever seen before. I also saw cases that I am sure constitute ARV failure - some of these guys were actively dying in front of my eyes. I was in med school and residency early in the AIDs/HIV outbreak - I have seen people acutely dying of AIDS, but I haven't seen that in years in the US. I saw it today, and it is heart breaking, especially when you know that there is help available for some of them. I also saw more Kaposi's sarcoma than I have ever seen before. It is tragic. The set up was one big room with a half wall separating Joseph and I. The prisoners lined up on a bench, usually 8-10 at a time in the room, with one guard in the room with us. No handcuffs or shackles. Outside was a group waiting to be seen of 200-300. When we had to stop seeing patients (they have to be back in their cells at ~3:30 PM) they rushed the door. They were desperate. I don't think they wanted to hurt us, they just wanted their problems addressed. At the end, when the other prisoners were dispersed, two men were brought in with additional guards and in shackles. They had been sentenced to life in prison and were scheduled to go to the big, 'final' prison in Zomba. We ended up running completely out of scabies medications. I saw more skin lesions, on more private areas, then I ever want to see again. I looked into the eyes of the sick and dying and had no real medical treatment to offer them. Some of these guys were young, some were very old. They all looked malnourished, which is probably one of the many reasons their HIV is out of control. They were dirty and their clothes were in tatters. They have limited soap for bathing, and they must wash their own clothes, by hand, usually without soap. They depend on 'well wishers' to bring them almost everything - extra food, soap, clothes, books, paper, etc. That prison houses ~26 women (several with their children under the age of 5) and ~2000 men. Charles has a prison ministry there, where he preaches and teaches. He is a much better man than I!

After that grueling day, we returned home to shower and then have dinner with Jim and Diane Young (she is the other doctor at the ABC clinic) and their kids. We had a great dinner of chicken curry and rice - it was mild enough that Joseph really liked it.

Please note - you cannot take photos in either KCH or the prison, so you guys have all been spared what my eyes have seen -and is burned into my brain - over the last couple of days.

Thanksgiving / Praise - our safety; our friends here; our supporters in the US; our awesome translators that are such a help and a blessing to us.

Prayer: for all the sick and dying folks at the prison - that they may come to a saving knowledge of Jesus Christ; for us as we wind down this trip; for the students at ABC as they begin college again; for the Maseko family, a precious family that is striving to do so much for their country of Malawi.

Pictures:

Playground at Pizza Inn with Emma and Angellah

The kids - tallest is Lindiwe, next Tristen and the little one is Alpha

Two of 'my' students at ABC - Wongani and Charles.

Aman and Mphambano

My last post, last Wed. was before the evening events - Aman, the little guy that has been in the Tiyamike ward for over 3 months, had a sudden and severe respiratory event. He has multiple congenital deformities, and no one seems to know what 'syndrome' it is... not that it matters, none of it is correctable. We all thought it would be nice to let the family know what to expect long term. He was 4 years old and weighed ~7 kg. He was able to talk, but his right leg was so deformed he could not walk. He had been in the ward because he was oxygen dependent (used a concentrator). Wednesday he complained of leg pain and then became extremely short of breath. We wondered then, as we do now, if he had blood clots in this deformed leg, that he was throwing up to his lungs. Joseph and I got a call Wed. evening to come now to the ward - the two of us, plus Carson and Becky and the ward nurses, worked with him for some time. At one point he stopped breathing and his heart slowed almost to a standstill. By a true miracle we were able to use simple resuscitation (BVM for the medical folks out there) and get him back. We used simple methods because that is all we have here! The one and only oxygen cylinder in the entire clinic was brought up from the operating theater to his bedside. By Thursday morning he actually looked a little perky and took something to drink. All day Thursday he held his own, but barely. Friday he had a few sips to drink and then stopped, just lying still, trying to breath. We prepared the family for the inevitable. He died Friday night. Pray for his family as they deal with this loss. The one good thing that came out of his death - the adminstrators for the clinic demanded the oxygen company fill some of the clinics tanks and they did!

There is always hope here, even when it seems dark.... Carson has a little boy from Crisis Nursery, Mphambano, who came in very malnourished. He is ~18 months old, has a full set of teeth, and weighs only a little over 6 kg (~13 pounds). He looks ~4-5 months old until he smiles at you! He is doing great with Carson, growing and interacting. He is a doll. Another great occurrence this week was little Chikumbutso's second HIV test was negative!! Yeah!! And lastly, my week in the clinic was pretty uneventful as far as my patients go. I always dread the patient that I cannot diagnosis or help because of lack of equipment, tests, etc. So, either my clinical skills are improving or I just got very lucky this past week!

Our weekend was spent quietly, I was packing for the return trip home - deciding what to leave; Joseph did some minor repairs around the house and studied. We both went to the carver's market to get Sue and Katie a couple things they had requested but had not bought. Thanks to Joseph's supreme bargaining skills, he was able to get the things they wanted at a decent price! Sunday was our last time at Flood church for this trip - how I will miss that church!! Then we invited our friend, Charles, and his family over for dinner. He is an ABC student. We met him last year when we was one of our guards and wanted to help translate in the village clinics. This year he is pretty much Joseph's 'private' translator! Charles lives on campus with his wife, Aleta, son Praise (2 y.o) and currently has two other children in the house, Enson (~4 y.o.) and Alinafe (11 y.o.) They all came for a big pot of beef stew. As Americans, we sometimes cook things that the Malawians do not like... I asked Charles if they had ever had a stew - a meal with all the meat, vegetables, and everything in one big pot. He said 'oh yes, in the village they will make a pot like this with animal bones, bananas and carrots'. Oh, yummy (NOT). Anyway, they all seemed to like the stew we made, even without the bananas! Afterwards the kids watched a cartoon video. A great time was had by all. Of course, dessert was served - Malawians tend to have a 'sweet tooth' just like we do - peanut butter and chocolate brownies.

Thanksgiving / Praise: for Chikumbutso's negative test; for Charles and his family that we may count them as friends; for safe travels; for my uneventful week in the clinic;for the non 'demonstrations' on Wed.; for Mphambano and his recovery.

Prayer: for Aman's family; for our continued safety; for this country as she faces multiple problems, that her citizens and legislators will work out satisfactory solutions in a peaceful manner; for us as we plan the prison clinic this week.

Pictures:

Musuwa family with us - Joseph, Aleta, Charles, Praise, me and little Enson on the floor (Alinafe took this photo and did a good job!)

Charles and family watching the cartoon video

Two photos of Mphambano (those of you who friend me on facebook will recognise him!)

A quiet Wednesday at home!

If any of you have been keeping up with Malawi politics, you know that today, Aug. 17th, more demonstrations had been scheduled. They were supposed to be peaceful, but the last peaceful protest ended up with live bullets, riots, looting and 19 people dead. The plan was to close the clinic and keep everyone at home and safe. Late Tuesday the word came down that the demonstrations had been canceled, but to err on the side of caution, it was still recommended that people stay home. So, we are home. I have caught up on emails, printed some photos I will be leaving with folks here, rearranged a bag that is staying here and starting packing to leave. Joseph is working on the car and then school work. Monday and Tuesday I was in the clinic (Dr. Young is on a family holiday), and my plan is to be there Thursday and Friday, also. We have one more clinic scheduled - at the prison on Tuesday. I have included photos of Chikumbutso, the crisis nursery baby that we are feeding in the inpatient ward. He is gaining weight (3.4 kg) and looking awake and perky! When he gets to 3.9 we will send him back to crisis. In the clinic yesterday we got to see the little one that Rosemary is fostering - another crisis nursery baby that apparently came in near death - she is chubby and smiling now! We also took the opportunity Tuesday afternoon to visit Charles, his wife and son, Praise, at their home. Charles was one of our guards last year and if you have been following the blog, you will recognize him as one of the our most used translators. He has been a great help to us in the clinics. We had some books and a toy car for Praise, along with a few other tokens of appreciation for Charles.
A family showed up in the clinic from Ntcheu. The mom and baby had been attacked and bitten by a village dog a week ago. They had been searching for rabies vaccine but to no avail. We had some in the clinic (both will need the full course), but they had no money, and had traveled from quite a way. Thanks to Peter at the clinic - he arranged for the rabies medications to be paid for! They will stay with family in a nearby village until the long course of rabies treatment is done, and the wounds will also be bandaged and treated at ABC. The mom had bites on her leg, her arm and her breast; the child had a nasty deep bite on the foot. Rabies in the village dogs and cats is a huge problem here.
Joseph did find one of the problems with the car - looks like a pulley has a rough place that is 'eating up' the belts, not to mention making a horrific noise. Unfortunately, we have no replacement parts with us!

Thanksgiving / Praise - no riots so far; that the government might take the citizens' concerns seriously; that Chikumbutso is doing so well; having Joseph here with his multiple skills!; for the availability of rabies vaccine at the clinic; our friends here in Malawi.

Prayers: continued safety; the upcoming prison clinic; our preparations for leaving in a little over a week.

Pictures:Joseph working on the Rav 4.

Loveness with Chikumbutso

Close up of Chikumbutso

Charles and family

Carson with the little one who is chubby and smiling (although not so smiley in this photo!)

Dog bite - leg

Dog bite - foot

Liwonde National Park

Once in every trip we try to get away for a few days to enjoy the beauty of Malawi. This is a lovely country! This time we decided to go to Liwonde National Park. It is considered one of the best national parks in Malawi. I was first there in 1994, when Mandy and I saw lions in the park! Now the park has only one lion who is seldom seen. However, they have a rhino sanctuary and we want to see rhino! With that in mind, we packed up and drove to the river crossing (Shire river) to arrive at Mvuu camp. There are two places to stay in the park -Mvuu lodge and the cheaper Mvuu camp. We arrived in time for a late lunch, then went on the rhino sanctuary drive. It costs $5 extra per person, but it would be worth it to see rhino! There are 13

or 14 rhinos here, along with other species endangered in Malawi - roan antelope, cape buffalo, sable antelope, Liechtenstein's wildebeest, zebra and black rhino. The sanctuary is fenced. However, turns out the fence is routinely knocked down by elephants who have gotten into the sanctuary. Zebra and at least 2 rhinos have escaped to the main part of the park. We saw warthogs and bush buck get through the fences while we were there. We also saw a wildebeest which had run afoul of a wire snare - so it seems that the poachers have breached the fences, too. With all that said, we saw all the endangered species except rhino!! Oh well, that will just be a goal for another visit! We did the sanctuary evening drive both nights, and for the morning drive we did the boat trip. We saw lots and lots of hippos, plus elephant, crocodiles and many beautiful birds. The food was good and the service was excellent. The national workers were charming. We spent some time talking to 'our' waiter, James. They work for 7 days straight, then get seven days off. When they are off, they are free to go to school or work other jobs. He is going to school, trying to get a degree in business. The group that runs the camp, Wilderness Safari, also has an outreach in the nearby villages, to improve their lives as well. The camp itself tries to be as 'green' as possible. Our chalet was a tent with toilet / shower attached, and the entire bottom area surrounded in stone. The first evening we had a boma brai (BBQ outside in the boma or enclosure). It was a full moon celebration. A large group of young people from Y MALAWI was there, too, making it fun for everyone as they joined in the traditional dancing. That night I was awakened by what I thought was Joseph getting into the luggage - all this rumbling around... then I realized he was asleep in his bed.. and it sounded like something coming through the top of the tent. As I laid there, thinking 'hippo', I heard loud crunching footsteps... I got up, out from the mosquito net and peeked out the 'window' in time to see two elephants (one big, one little) walking away from the back of our tent. Apparently they were eating one of the trees that lean over on the tent. How funny! The next morning we took the boat safari down the Shire river. Very nice and I recommend it! We brought books to read and Scrabble to play in our 'down time' between safaris and meals - I must say that Joseph was good and completely finished the book he brought. I just slept and slept. (I was bitten by several tsetse flies, so I am going to blame my sleepiness on that - what do you think??). We had a very relaxing time.

On the way home we did not find fuel, even though we passed through several towns with filling stations. We arrived at the outskirts of Lilongwe on empty. We saw a station pumping, so as we pulled in to get into line our 'fuel light' came on.... while we were waiting a young Malawian chewing on sugar cane approached the car, stating he wanted to assist us - that he would go fill our jerry can. He said he was parked on the side of the road waiting for diesel, and they only had petrol. We have sat in lots of lines and never had this happen. We have also sat in lots of lines BEFORE our 'empty' light came on.... he and Joseph went to the pumps and had the jerry can filled (10 liters). Joseph said it was a mad house there. After putting the petrol in our car, the Malawian suggested going back again (good idea)... but they totally ran out of fuel (we have never had that happen before, either). However, the jerry can of petrol gave us enough to get home - and the station by our house was pumping! So, after dropping me off to unpack and start dinner, Joseph went back and got a 'full tankie' as they say here. Yeah!! I think the helpful Malawian was an angel in disguise. Joseph thinks I am being melodramatic, but I doubt we would have made it home with the light on, and I suspect we would have been pushing the car in that last petrol line even if we had made it that far. We are happy, we think this tank will get us through to the end of our trip!

Thanksgiving /praise: for fuel; for safe travels; for a God that has made our earth a beautiful place, with creatures great and small to reflect His glory!; for our health.

Prayer: for continued travel safety; for continued health; for me as I start working for Dr. Young on Monday; for Malawi as the possibility of renewed demonstrations on the 17th loom large for us; for our families at home - that they continue to hold up with added burdens while we are gone.

Pictures:

James, our waiter, and Joseph

Malachite kingfisher

Sable Antelope

Liechtenstein's wildebeest (there are two photos of him, sorry!!)

Joseph on the bridge in front of the Mvuu camp meeting place

Water buck

Goliath heron

Yellow billed stork

Fish eagle

Hippo running

Pied kingfisher

Egret in flight

Return to Gusu

On Wednesday, we joined forces with a team from Washington State that included two nurses; a group from California that included a doctor, pre-med student, EMT and nurse; along with our nurses from ABC, Carson and Becky; and the high school student, Kristen, who has been shadowing Carson and been such a help on village clinics. We also took 4 translators - Oscar, Charles, Esnart and Sandram. We all piled onto the bus and the Epperson truck and away we went for the 2 plus hour drive. Sam Kawale (Gusu is his ancestral village and his 'ministry') came with us and gave everyone an idea of what they are trying to accomplish in this village - health care, food security, spiritual growth, education and micro finance.

We arrived to find a line of patients waiting. Everyone pitched in and we ended up seeing over 300 folks (I didn't keep count, Becky did this!) We saw the usual problems - many of which are worsened by their lack of routine care, general hygiene, and understanding of basic health care. What we take for granted - washing wounds with soap and water, keeping them covered, taking Tylenol or Motrin for pain / fever, protecting yourself and your family from breathing in dust, smoke and other pollutants, washing your hands after the toilet and before eating, kitchen 'hygiene' for lack of a better word, clean, safe water.... these things are either not known or not available. As Joseph says, there is no CVS around the corner! The dust and smoke (from fields being cleared, trash burning and cooking fires) are non-stop. It gets in their lungs and causes chronic coughing, it burns the eyes, the sparks from the fires can burn the corneas, kids (and adults) with seizures can fall in the fires... the list goes on and on. It can be overwhelming. The government appears to be short of medications, so many people we see know they have a medical problem but were getting their medications from the government facilities - now there is no medication and they have no money - or transport- to go to a pharmacy. There are no medicaid, medicare, indigent care, food stamps or other welfare programs here. The medical system is socialized as best as I can tell, with the poorest people getting free or low cost care at government facilities. Unfortunately, if the government is out of something, that means the patient is out of luck! Transportation alone can be a huge challenge - most people walk everywhere. Lucky ones have bikes. There are a few motor bikes. The village folks don't have cars and the minibuses only come along the main roads. It can be very sad and very frustrating. I always hope that we make a difference in some lives when we are there. On the bright side, we saw Taona, the girl we found in this village 6 weeks ago with an open fracture. She is back home, walking on an almost healed leg with good range of motion in the knee and adequate strength in the leg. We also saw Jonas, the little boy with the seizures who had fallen in the fire a couple of times and had infected burns. He was almost totally healed from his burns. I gave the dad a crash course in scar management (thanks to Sue Cantrell for teaching me that!), and we refilled his seizure medications. He had only had one seizure since we started him on dilantin. We were excited to see these two kids doing so well! For the medical folks out there - we saw a child with a diagnosis of sickle cell disease (he will probably not do well in the village), who also had some type of heart problem (the government hospital noted in his health passport that they thought it was VSD, I am not sure). He had significant clubbing. I saw a child that I am pretty sure has Down's syndrome - but no mention was made in her health passport and the Mom did not know she had any health problems. She was there for ear infections. Another older guy who smoked (pretty unusual actually - they grow their own, but most sell it as a cash crop, they don't smoke it) - he was short of breathe and had clubbing. A child with a hand and foot rash - looked like terrible eczema, but her nail beds had changed so she might have had a psoriasis problem, too. Lots of minor wounds on legs, one gentleman who had pulled a thorn out of his thumb 2 weeks ago, now he had massive swelling of the hand - however, since it was not red or hot and only minimally tender, we thought we should not open it up there, but send him to the hospital. Another man showed up with the worst foot wound / infection I have seen here. He said it was 5 years old and denied any trauma as the starting point. However, it looked like ~1/3 of the sole of his foot had been exploded - whew and it stank (like pseudomonas!) It was nasty, nasty! I think he may have the infection in the bones as well. We washed and bandaged, but told him he needed to go to the government hospital. The last gruesome case was a lady with a lesion on her heel. It had started 3 years ago with a small area that bled, then it began to grow and turn black. It had not grown lately and was minimally sore to her; to touch it was rubbery and not particularly tender. Dr. Mike and I consulted - we think it was probably malignant melanoma, although the history doesn't fit exactly. Using an interpreter you never know, though.... we referred her to the government hospital. If is it melanoma, she does not have a very good prognosis at all. After we finished the clinic, while on the way home - bouncing in the bus, exhausted, dusty, mentally fatigued, we got a call from Fredna Brown. They invited us to dinner - what a wonderful thing! We got cleaned up and went to their house for goat stew, rice, cornbread and chocolate pie. It was heavenly! And we always enjoy our visits with the Browns - they have a great sense of humor and tons of funny stories.

Thanksgiving / praise - travel safety; friends such as Gaylord and Fredna Brown to fellowship with here in Malawi; supporters in the US who give so generously of their money, their medical supplies / clothing and their prayers!!; Taona and Jonas and their recovery; the safe arrival back home of Sue and Katie.

Prayer: our continued road safety and ability to find fuel; that somehow we touch lives in a meaningful way, even when we are fatigued and discouraged; that our families back home will stay safe in our absence; that we can be a mirror to reflect Jesus at all times.

Photos:

The bus and the truck.

Taona and her family in front of their home

Distributing clothing brought by the Washington State Team

Dr. Mike and Oscar

Joseph seeing patients

Hand lesion with nail involvement

Clubbing in older man

Two photos of Jonas's healing burns

Me holding child with possible Down's syndrome

Family portrait

Foot lesion - malignant melanoma?

Hand that had thorn removed, hand still swollen

Foot wound

Entire set up at the front of the church

Dr. Mike and Oscar

The pharmacy set up

Me,laughing at something Joseph said...

Shop on the way 'Slow but Sure', on the dust road to Gusu.

A little guy watching us roll by

The bus - Sandram and Carson with a member of the Washington State Team

Same Kawale as he talks about Gusu.