"I have this guy with severe anemia..."

"The woman with TB and the drug rash is back."

"Msukwa is here for new TB medicines."

"A new client from South Africa brought this chest x-ray..."

These requests from Malawian colleagues draw me away from the hospital ward, where patients await.

A young HIV-infected woman returns from her endoscopy.  The lesions in her throat are better and she can swallow now, but the medication side effects are debilitating.  An HIV-infected man is dying from a pneumonia we have fought to a standstill but cannot vanquish.  A 24 year-old, HIV-infected since birth, has fungal meningitis, syphilis in her spine, and a severe skin infection which she may have contracted at our hospital.  Another 25 year-old HIV-infected woman with meningitis weighs just 25 kilograms, or 55 pounds--not much more than my young sons.  A 23 year-old student, free of the HIV virus, recovers from pneumonia and a rare form of heart failure.

So goes only the partial litany from only a partial morning.

And Amanda and I just found out, two days before a long-planned safari to Zambia, that Aaron's passport has expired.  I am frazzled, stretched, completely worn out.

Now what?  What does this young woman standing here want with me?  Who is she?  Can't these people give me a break?

Khonjera, a hospital guard, motions.  "This is Enelesi, from Moyo Clinic.  She wants to see you."

Enelesi.  I remember now. 

19 years-old, HIV-infected at birth.  Failed first-line HIV treatment.  After second-line therapy, her immune system vigorously struck the TB hiding in her lungs.  Initially we thought it was a different pneumonia.  We were incorrect.  A weekend of the wrong therapy, I find her near death.  TB medicines.  Steroids.  A $3 special oxygen mask.  She fights, breathes 50 times a minute.  Survives.

Enelesi is a boarding student, doesn't want others to know her HIV status.  Hides her meds, doesn't take them.  TB returns, this time in her brain.  A colleague threads a pipe down her nose, to feed her crushed, life-saving drugs.  Wakes up, survives. 

Starts HIV treatment again.  Next, she cannot see.  The immune system, rising, moves against the virus lining her retina.  Back into the hospital for two weeks of a special drip, then home with a donated medicine costing about $1,000, to keep the eye infection at bay while her own immune system takes up the job.  Vision improves.

Here she is.  Enelesi.

"I did not recognize you.  Mukunenepa."  You are becoming fat:  a Malawian compliment, no insult.  She smiles, says nothing.  I gesture to step out of the hallway into an exam room.  "Is something wrong?  Can I help you?"

Tears.  Only tears. 

"I know how hard it must be to have this disease, to be in school.  Do you want to see the counselor?"

"No, I am fine."

More tears.  No more words, just tears.

She just wants to give thanks.  She can't say it.  Her presence and tears do:  I am here!  I am alive!

A minute earlier, her doctor only wanted her to go away, to leave him alone, whoever she was. 

Lord, have mercy on me, a sinner.

The doctor never learns.  A month earlier, same story:  Supplicants, beggars, I need this, please help me do that.  And now who is this woman sitting here, staking a claim on doctor time?  "I am Mtama's mother and want to thank you for everything.  She is fine now.  May God bless you!"  She offers popcorn kernels, because, she says, "I hear you like popcorn."  Who doesn't?

In the lyrical opening to his African masterpiece Cry, The Beloved Country, Alan Paton's narrator tells of a land "lovely beyond any singing of it."  He speaks not simply of nature, of landscape or wildlife, but of a complete, integrated land--a continent and culture and people.  Beyond dark plague, behold bright, shining splendor "lovely beyond any singing of it."