Dear Friends,

Last month, over a course of eight days, we witnessed eight fatalities.  Most of these were needless, horrible wastes of human life-and most (though, honestly, not all) resulted from mismanagement prior to arrival at Partners in Hope.  The calls from the ward became a steady drumbeat of death.  My anger and frustration rose with each loss. 

"When a human being dies, it is like an entire species becoming extinct," a physician once wrote, herself a patient confronting a chronic illness.

I seriously wondered why I am here.  So badly and carelessly were these patients treated, I had to ask myself:  Am I in Malawi to save the lives of people made worse or ignored by the medical system?  Isn't there enough to do somewhere else just dealing with sick people who come first to your door? 

At the end of this two week period a clinical officer called me to the free HIV clinic.  A complicated patient I had previously treated was in the emergency room and very ill.

Safuli has devastated lungs due to a past run in with tuberculosis.  Although her HIV infection is well-controlled, she struggles with chronic cough, shortness of breath, and frequent bouts of pneumonia.  The mangled airways can't expel the dust and bacteria which a normal pulmonary system just shrugs off.  Last year a visiting doctor taught her family how to perform chest physical therapy:  They pound on her back, and the debris is knocked loose and disgorged.  It's a pathetic sight.

I had not seen Safuli for six months.  I found her in extremis, struggling to inhale, flailing.  Quickly assessing the situation, I assumed another episode of pneumonia had set in.  I bent over to measure her blood pressure and pulse.

Her arm, flaccid and uncoordinated, slowly rose and fell, her limp hand coming to rest on my head. 

"Dr. Fielder, help me."

Plaintive and desperate, her action and words had the effect of a reverse blessing.  In many churches, the pastor or elders lay hands on the physically ill.  Here, the physically ill was laying a hand on the would-be healer, who himself was looking for balm and blessing.

I was reminded why I am here.

We took Safuli to the inpatient ward, discovering that heart failure and a blood clot were as much responsible as the ravaged lungs.  She improved and was discharged, but then a piece of that clot dislodged and found its way to the lung, and she wound up back on the ward.  Once again, she is on the mend.

And so am I.

Last week a call came from an unfamiliar number in Kenya.

"Fielder, it is Margaret!"  I strained to believe it.  "Nani?" ("Who?"), I replied in Swahili.

"It is Margaret, from Kenya!"  The voice was vibrant and alive.

The line went dead.  Even that short call would have required an extravagant amount of credit.

I had first cared for Margaret in August 2003 when she presented with advanced HIV and tuberculosis during the second trimester of pregnancy.  Her son was named after me.  She had recently been re-admitted to Kijabe for malnutrition and multiple fractured bones.  Someone had provided her with my number.

Margaret and her family once gave us a turkey, a gift they certainly could not afford and would have benefitted from consuming themselves.

Again she had spent what she did not have, just to say, or so I imagined, "I am still here.  I haven't given up.  Your work has not been in vain."

Grace,