It was a relief to had finally step off the airplane to face the welcoming sign announcing the Malawian Interntaionl Airport. It was hard to imagine that Elizabeth and I only left Houston three days ago. The long airplane rides and the lessons we learned along the way all seem to blend into a murky dream. Stepping foot on the airport where people are all jostling to find their bags on the only conveyor belt and where the sounds of squeaking go carts pierce the air quickly awakened me to the nostalgic atmosphere of the wonderful country Malawi. To make our travel adventures short some lessons we learned along the way:

–          Never eat beef and cheese burgers on the airplane or else risk the body forcefully ejecting it out (i.e. I threw up)

–          When the check-in and carry-on bags must be switched, make sure to switch the liquid substances as well or painfully observe brand new toothpaste and body wash discarded

–          Always arrive an hour early in Johannesburg airport to check-in. We had to rebook our flight from Johannesburg to Lilongwe—in the process, staying an extra night—because we missed the mark by about 15 minutes.

Driving from the airport to St.Gabriel’s Hospital, I was filled with an intense déjà vu; after all I had been here before on this exact road a year ago. However, what was so strange to me was that nothing has changed. Malawi seems to stand still amidst its red dust. Everywhere kids and adults alike were walking barefoot on the red sandy sidewalks beside the paved road. Woman were balancing huge baskets of produce as they walk while babies were strapped saddle on their back; men, riding their black bicycles carrying goods or their families; kids, playing outside or trying to sell mice on sticks to passing cars. The towns were filled with animals and people conversing outside buildings that badly needed repainting or even reconstruction. Homes are still isolated villages of clay and straw huts with open fires to cook. Strange half-finished brink constructions sat on the side of the road without a shadow of a worker in sight. In fact, the only change I saw was a diversion of traffic and the road for the new, blindingly white Parliament building in front of a billboard that promised the roads would be fixed at a “record rate”….

Starting our first day at St.Gabriel’s Hospital, I was glad to discover many changes. The ART ward that I saw was in construction the last time had been opened for six months now. I remember the days when HIV patients would line up crowding the OPD hallway to wait for their check-up and next dose of medication. Alex, the nurse in charge of ART and community outreach, would see patients in a narrow room where one side there would be a small table and the other side, shelves of crammed records and medicine. Now the ART ward is a spacious building where patients can wait outside in the open air under the shade to wait their turn in the reception room. There were rooms for each of the jobs: dispensing and storage of medicine, pill counting, records keeping and offices. I think the ART clinic opened at an opportune time as Malawi has a HIV prevalence rate in the teens; it shows that the hospital realizes and places importance on the HIV/AIDS issue.

A hospice and palliative care unit also opened adjacent to the ART clinic. In the past, Matilda– the nurse who worked with a previous intern Z on the community health worker backpack—would ride a motorbike to check on the patients on palliative care (I still remember the time when the motorbike broke down when I was with her). Now patients are housed in this clinic where the nurses and doctors can try to make the last few days for them as painless and peaceful as possible. The project is something new the hospital is trying out. Patients are referred from the wards where proper assessment of the condition is used to determine whether the patient can move to the ward in order to minimize overcrowding of the small unit. Foreign doctors seem to head the effort for this project as the Canadian resident Ilene (on a 6 month program) is the main doctor who makes rounds in the afternoon. She along with the nurses for the ward work part-time as they have other hospital duties in other wards the other half of time. We had an opportunity to sit on their bi-monthly meetings where they discuss challenges they encounter such as mothers who refuse HIV testing or caregiver fatigue. One particular problem is related to the free-of-charge policy the hospice has enacted. Many patients in the wards request to be admitted because they know that care is free. Despite the problems, the nurses and Ilene recalled fond memories of patients who passed away and the grateful thanks they received from the family members.

I am once more glad and proud to be in this small but exciting hospital. While the landscape may not have changed, the hospital continues to explore new ways to bring healthcare to the quarter million Malawians it serves. The downside this summer is that the hospital is experiencing an internet crisis. We barely have 10 minutes day, segregated at random times of the day that are hard to catch. We would have to travel to Lilongwe to use internet cafes to use the internet.

Malawi has been an amazing place to implement our projects. Whether it is because Malawians are simply very open to change or because Elizabeth’s familiarity with the place allows us to find the right people, the institutions I have approached with the bili-lights have been absolutely excited to accept it so long as it works.

I left one bili-light unit with the head pediatrician Dr. Mwansambo at Kamuzu Central Hospital in Lilongwe. I had the opportunity to meet him with the great help of Baylor PAC pediatrician Chris Buck who, in the past, had helped Beyond Traditional Borders test and evaluate the Diagnostic-Lab-in-a-Backpack. With one quick phone call, Chris scheduled an immediate meeting with Dr.Mwansambo. It is an understatement to say I was surprised. I was prepared for the long battle I had in Swaziland, the repeated meetings with hospital heads in order to push for the bili-lights. Even in the case of RFM, I could only force a decisive vote during the last week of my stay, using the fact that I had to leave as leverage. The simple heads-up phone call between Baylor and Kamuzu is a testament of the close relationship the two institutions share, which marks it the real difference from the case in Swaziland. In fact, Baylor is physically attached to Kamuzu and thus, Baylor doctors regularly round the Kamozu pediatrics ward.

Dr.Mwansambo was a heart-warming man, doctor and DJ whom I had the pleasure to meet. He possessed an open, friendly air and an impressive basic engineering knowledge. He was the first person on this trip to know what LEDs stand for and how they work. Throughout our meeting, he was bombarding me with not questions about certification, but technical questions about shock resistance and parallel/series circuits. He grew increasingly enthusiastic about the device, given its low-cost and easy maintenance. The hospital had previously experienced huge issues with high tech technologies being donated or bought, only for them to be broken and unfixable in a short span of time. If the pilot unit is well-received, he is looking forward to using more models when the maternity ward reopens at the end of this year. Currently, all deliveries and neonatal care are referred to Bwaila, an exclusive maternity center that delivers at least 1000 births per month. Once the new maternity ward is finished, most patients would then be transferred to Kamozu—an average of 30 in-labor mothers per day. The bili-lights and incubator would then be huge necessities for neonatal care based on such demand. In the meantime, the bili-lights will be used in Bwaila under supervision by Dr.Mwansambo who rounds there periodically. Moreover, Chris has been wonderfully helpful in eliciting the help of Dr.Eric McCollum, another PAC pediatrician, to check on and evaluate the device along with the Malawian staff. I feel, after the meeting, that I had established some of the most reliable contacts–people who are excited and truly interested in the success of the device. I am excited to hear feedback from them.

We have officially and completely hand over the incubator and bili-lights to St.Gabriel’s this week. Ideally, we wanted do this earlier, but the incubator took a long time to complete, both to build and to test. I am surprised to discover just how inefficient the light bulbs were; we went from 4 100 W bulbs to 4 clear 40 W light bulbs, testing tinted and clear options for each wattage. However, once we demonstrated the devices to Matron Kamera and Dr.Mbeya, they have been quick and wonderfully supportive in helping the devices settle into the hospital (there was never a doubt that the hospital would pilot the technologies since we mentioned them on our first day). Matron Kamera scheduled a maternity ward nursing/cleaner meeting—there is an amazing task shifting to the cleaners as they are very well educated—for us to briefly train the staff on the important issues of usage and safety. Dr.Mbeya helped us gather the doctors so that their knowing the presence of the devices will encourage them to use the incubator and especially the bili-lights when the time comes. We had a check list of all the tasks we had to finish for the devices and Matron Kamera and Dr.Mbeya just helped us cross each one off one after another in less a one day. The people at this hospital do their work with an incredible level of efficiency and dedication that I have not seen anywhere else in Africa. I can leave the technologies here with a peace of mind, knowing that this amazing group of people will use it well and correctly.

I finally had the chance to visit the Queen Elizabeth Central Hospital in Blantyre, the first pilot place of the bili-lights and the founding place of the incubator design. On their two weeks adventure through Africa visiting all the interns, Dr. Richards-Kortum and Dr. Oden visited us at St.Gabriel’s on the last leg of their journey and then took us with them to Blantyre. It was a wonderful three days with them and they arrived just at the right time: we finished building the incubator that week. I am very grateful to the Namitete Furniture Factory. They had gone beyond professionally to help us every step of the way from woodcraft to wiring. We would walk to the factory every morning to “supervise”—more like stand and watch—as the incubator was assembled. We came to know the managers very well; they were such openly assessable people who we would shake hands with as we entered the factory complex, who every so often personally walked to our station to check on our progress and who offered us coffee during the morning tea break. It was a pleasure to work with these friendly, easy-going people and, especially with Eric, the worker put exclusively in charge to help us with the project. We became such good friends with Eric that he invited us to his wedding on August 1^st. I so want to attend, but our plane back to America leaves on the 31^st. I hear from Elizabeth that Malawian weddings are quite the experience. Sadly, as friends, we did not make work easy on Eric. We continuously found mistakes in the incubator directions as we built it–the dimensions in centimeters were wrong, the acrylic cover specification, inappropriate, the electrical wiring, unclear. Our progress was continuously delayed by our need to communicate back to the States for confirmation and the daily power outage we experienced. Through it all, Eric was extremely patient, double/triple checking with us on each step and kindly offering his professional opinion like what type of varnish we should use. In fact, I am pleasantly surprised at the professionalism of this small factory in one of the most rural spot on Earth. It is equipped with all the essential, hefty machines and personnel skill to turn questionable wood into elegant, sturdy products. I have to admit I was at first skeptical of the factory when I first saw the pieces of pine wood—multi-colored, irregular, disfigured with holes– that were glued together to meet the various parts’ dimensions. However, I soon stood corrected. The workers sanded, polished and crafted the wood into a beautiful incubator, so strong that we often joke that not even a baby can break it.

What is amazing is that they helped us cut the wood, built the incubator, installed the electronics, and varnished the entire thing. All for about $120. If the incubators were mass-produced, the cost can be sliced even further. That is truly incredible prospect in a country with a fertility rate of 6 children per woman and infant mortality rate of 89 deaths per 1000 live births. However, that is not to say the incubator cannot be improved. The most costly and inaccessible component of the hot cot is the acrylic glass used as the cover lid. There was no way we could get it here in Malawi (we brought it from US) and it was extremely expensive even in an industrial country like Swaziland. I think glass is a more economically suited substitute although it does present the possibility of shattering on the infant. Moreover, the current incubator design doesn’t take into account the prevalent shortage of nurses that we have seen in Swaziland and Malawi. A Holland nurse we meet here is very surprised at the nurse to patient ratio here. Whereas in her country the ratio is 1:6, here the one or two nurses on duty are in charge of the maternity ward, the labor ward, the post-surgical delivery ward and the post-natal ward all at once. At situations like this, nurses want to be able to see in a sweeping glance that babies in the incubators are there and doing well. Unlike the conventional incubators with transparent sides all round, the hot cot’s wooden sides and rather tall height forces the nurses to walk over to each crib to check on the babies from above. The cost would increase substantially if we were to install clear material on all fours sides of the hot cot, but I think at least transparency one side might be a good option.

Or, we could adapt the ingenious method Queen Elizabeth Hospital (Queen’s) at Blantyre used: cutting the height of the incubators to less than half a normal person’s height. Standing at one end of the room in their busy nursery, I could see a row of babies in their hot cots with one sideway glance. I remember my initial puzzlement at the short height of the incubators when I first looked at the original designs from Malawi a year ago. At the time, I attributed the reason to the possible differences in height. Only when I personally saw Queen’s–experience Africa–did I realize the true reason. My astonishment and my admiration of this simple design is only a small reflection of my deep respect for this amazingly creative hospital. I am extremely grateful I had a chance to visit and meet with the pediatricians I had only corresponded through emails. We were introduced with Dr. Elizabeth, a clear-headed Scottish pediatrician with a stern air but a quirky sense of humor, and her great counterpart, Dr.Kirstin Mittermayer, the German pediatrician with an enthusiastic bordering on bubbly disposition. Together, they were obviously two pillars of strength, two great forward-thinkers, in the maternity ward, one of the busiest places I have ever seen.

Taking a walk through the ward, I saw babies everywhere. Lining in rows at the center of one room, small white cubicles–not unlike the stereotypical salesman cubicles–enclosed upon dozens of wiggling babies. All the available machines in an abutting room were in use, some exceeding the limit of one infant at a time. The difference that separate this ward from others I had seen was the wooden incubators lining the edges of the walls—the originals. They were shrunken versions of our modified version, their small size allowing them to capitalize on the scarce resources. As the room was partially heated, the incubators could also afford to have larger slits. I never had the chance to see the original designs when I first worked on the incubator, but seeing it now, it gave me a sharper focus on the project, a sense of definition. It is just amazing to go back to the very beginning with the knowledge of everything that happened afterwards. I saw the need that prompt the modifications that were made to improve efficiency, but at the time, I also felt there were still much to be learned from the first generation. While our version is better from an engineering prospective, the size and bulkiness of the design is a limiting factor in the social and resource circumstances in Africa. I am definitely interested in the hospital’s response if they decide to follow the revised incubator instructions we left them.

Of course, there were the bili-lights, propped on top of the wooden incubators. I felt honored that that the lights I helped made were being used. It was surreal to actually see babies under the bili-lights I made last summer. I thought about it, dreamed about it, but I couldn’t believe I was actually seeing it in a hospital setting rather than in a research lab. I had forgotten how small the old models were. The doctors were definitely glad about the increased size of the new generation, which gives a larger irradiating area for leeway in case the baby moves. The new feature of intensity regulator was a great plus. In the past, the only way they could adjust the intensity was to pluck off different number of LEDs. Now, in addition to the intensity knob, the electrical components were all sturdier. Walking into the ward, Dr.Elizabeth and Dr.Kirstin immediately wanted to compare the new model with the old. It was a furry of movements—measuring, evaluating, experimenting. I love and appreciate the enthusiasm and interest the two doctors showed toward new technological advances. Within three minutes, they were already suggesting practical features that would make the bili-lights even more suitable to their needs. And the needs are great. They have at least two to three infants under phototherapy each day; they are even expecting the number to increase as they switch to a new meningitis medication that increases the likelihood of jaundice. I am looking forward to exploring into the issues they brought up such as a way to lock the intensity knob and the possibility of hanging the device.

It was a mere two hours at Queen’s but it was an amazing experience to see the founding place of the projects that drew me into the realm of global health. Working on the bili-lights and the incubator during my freshman summer was the definite starting point of my interest in how technology can play a role in healthcare of the developing world. Before, I had an interest, an obscure purpose. Now I have faces to relate, stories to associate, and memories to recall that define what I am doing. It was truly a full-filling two hours.

One thing I really hope to look into more after this trip is a transcutaneous bilirubin detector. Queen’s had recently obtained one, but it is a very expensive piece of equipment. Before, Queen’s method of diagnosis for jaundice is much like that of rest of Africa: physical examination. Even for a hospital like St.Gabriel’s that has full chemistry capabilities, it has trouble testing bilirubin levels because the reagents are hard and expensive to obtain. Government hospitals like the one we visited in Zomba have expressed much interest in this addition to the bili-lights.

As a whole, the three days we spent with our professors were unimaginablely busy and insightful. We jumped from meeting to meeting, hurrying from appointments with PEPFAR and UNICEF representatives to touring government hospitals like the centers in Zomba and Blantyre. On one day, we didn’t even have time to eat until late evening. I don’t know how my professors maintained this hectic pace for three weeks. The level of constant activity, tension and excitement is both exhilarating and draining. It was amazing to meet with so many great people, see so much and learn over the shoulders of giants, all in such a short amount of time. I am grateful that the professors shared with us a little of their incredible lives.

I haven’t been writing as much in Malawi because time just seems to fly here. There is so much to do, so much to experience that I can’t really make myself sit down and write.

So far, to me, Swaziland and Malawi have been two very different experiences. Maybe this is inaccurate on my part as I am comparing a rural Malawian village to the capital of Swaziland. However, I have briefly visited a Swazi homestead and my mind pulls up such huge contrasts. I remember the rolling mountains of Swaziland, imposing compilations of withered granite rocks and persistent greenery. Homesteads perch in this landscape are islands of impressive cultivated land seemingly miles apart from one another. It is a quiet image; I only remember the howl of the wind. Here in Malawi, I am surrounded by sound, music, activity and flat expanses of red dirt. Chickens, goats, cows room freely, offering great amusement to the guard dogs at St.Gabriel who often playfully chase after the goats to nip their tails. I hear the constant chatter of Chichewa outside my window as Malawian woman wearing traditional cloth wraps walk barefoot to the hospital. In the afternoon, the shouts of children asking us to play soccer with them would drown all else. The villages are just teeming with kids, running freely—whether it is school time or not. Malawians love to have big families where there could be as many as ten children whereas in Swaziland, women are embarrassed, if not ashamed, to have more than two or three. The village kids’ favorite activity when they see us is to jump up and down and shout “azungu” meaning foreigner. Then a herd of them—15 to 30 kids—would gather behind us as we walk and follow us to our destination. Foreigners are huge, fun, open-eye, finger-pointing spectacles here, much different from the discreet glances we received in Swaziland. Overall, I think Swaziland is a much more westernized nation where Elizabeth and I have to pay to go to a special cultural village to experience the Swazi old way of living. In Malawi, people embrace and live in their culture, speaking their own language—barely knowing English–, dressed in traditional garments and living life in ways passed down from generation to generation. Their openness of their culture makes us become easily incorporated into theirs.

The Malawian culture is such a friendly one, full of some of the sweetest traditions. I have not been into a village so open to each other and to foreigners. If we do not initiate “Muli bwanji”—how are you—, mothers wrapped with babies on their back and grandmother in head wraps would stop randomly on the street and greet us, maybe to shake our hands as well. It is such a special greeting because they would not ask it to the group but would repeat the question to each person, individually, one at a time. Looking back, it can be a time-consuming process, but really, I love the intimateness of the gesture, the valuing of each person personally. On top of this, Malawians are also very polite. Zokomo, meaning thank you, can be used or heard everywhere. You can pass someone on the street and say Zokomo. There is no excuse me, but zokomo. There is also no “you are welcome”, only zokomo as the response. The decorum of respect to individuals is quite heart-warming; here, people take the time to show a little care and respect to their neighbors and passbyers. Like many traditional societies, relationships are important, as can be seen in introductions. Here, Elizabeth isn’t Elizabeth, but the sister of Joshua (her brother who implemented FrontlineSMS). Mrs.Nesbit isn’t only Casey, but the mother of Joshua, Elizabeth and Daniel. I am not just Yiwen, but friend of Elizabeth and the Nesbit family. Relationships here define a part of you and help others relate to you. What is interesting is that relationships appear to matter more than your social position—your profession, property or education. Although in those aspects, the villagers are mostly homogenous. Almost all families are in some ways subsistence farmers. Even the workers at St.Gabriel who lives in Namitondo have small plots of land they farm for maize and vegetables. Most kids attend primary schools; secondary education requires money and thus is harder to obtain. No one I know has received a college education, whether it is because of money or that most secondary schools do not prepare a student adequately for university. There are technical schools, though, that train people after secondary school in specialty areas such as secretarial work, carpentry, medical assistant and such.

It is not only the Malawians who are especially nice; I have had a wonderful time living with the Nesbit family. I had a wonderful July 9^th birthday with them. Despite my being with them almost every minute of the day, they still surprised me with cupcakes they ordered from a neighboring cafeteria and a gift—a beautiful traditional cloth Malawians use to wrap around their waist as a skirt and protective wear to keep what is underneath free of dirt. We shared the cupcakes with our neighbors: three medical students from Luxemburg, an American pre-med student and Joanna who is in charge of the mobile CD4 machine. It was a great opportunity to have a chance to talk with everyone and take pictures of course. Earlier during the day, Elizabeth also personally cooked one of my favorite breakfasts: scrabbled eggs with oven-toasted bread. For dinner, traditionally at home, my mom would always cook noodles for me as noodles signify long life. By pure chance, the dinner Mrs. Nesbit had long ago planned, without knowing the date, was oven cooked ramen noodles with vegetables. The coincidence! It was a great, unforgettable birthday. I am so happy that I had it in Malawi and grateful that I shared it with the Nesbit family and a delightfully unusual gathering of individuals.

I really love the villagers around here and I am comforted that St.Gabriel Hospital is here take care of them. The HIV/AIDS service inspected periodically by the government ministry of health is consistently rated number 1 in the region. HIV is a problem here, but it is not a staggering shock as it was in Swaziland where it seemed like one in two was HIV positive. Especially in a rural areas like Namitondo and Namitete, HIV one of the serious problems next to malaria, tuberculosis and malnutrition but not THE problem. It is interesting to see a slight change in HIV treatment here. In Swaziland, the two popular first line medications are AZT and Nivarapene. Here, AZT is used as a substitute because of its dangerous side-affect of anemia, given the constant danger of malaria here. Moreover, second line drugs are extremely hard to obtain. There are only a handful of patients on it. As mentioned before, the hospital has one of the most extensive community health worker programs I have seen with trained staff going almost everyday to even more remote areas to do follow-up care. I have yet to go on one of these outreach trips because the staff can only take one extra passenger on their motorbikes (!). Elizabeth gets priority because she needs to work on the community health worker backpack, but I hope before I leave, I will get to go on at least one trip. I heard that the motorbike ride is quite thrilling. In terms of lab equipment, the hospital has the capability to run full blood chemistry tests and provide ultrasound, x-ray or microscopy services. However, whether there are enough trained technicians to fully use the capabilities is uncertain. The hospital is constantly making the effort to improve itself. Whereas in the past they had to refer—in essence abandon—patients who needed surgery, whether it is for biopsy, tumor resection or amputation, now they have a retired German orthopedist here to guide and train the surgery department. They have one theatre and will open a new one later this year. Patients being retained in the hospital are already constantly maxing the hospital’s current capacity due to the number of surgery patients. It’s feels great to be here!

Malawi—we learned from Alex, the head nurse—means the land of flames. Fitting for this land where the wind blows the red dirt to paint all things, where decrepit red brick shacks dot the landscape, where the kindness and generosity of its people burn for all to feel their warmth.

The people are just so friendly and welcoming. They have such beautiful smiles. Their faces crack along the laugh lines at our first greeting in Chichewa; it seems as if they become your friends with the first hello. Since very few villagers know English and as we know only the basic exchange of “how are you” and “I am fine”, we would walk away soon afterwards, hearing giggling and chatter behind us. Looking back, we would see them waving and laugh with them at their exuberance and at our own lack of understanding of their language. It was a spectacle when Elizabeth took me to explore the village of Namitondo for the first time. We would say hello to a woman drying her maize in a field and immediately, the surrounding women rushed toward us, bring and calling their kids, to shake our hands and exchange greetings. Walking away, we would leave a mass of Malawians in their tattered shirts and traditional wraps weaving madly at us. We were apparently quite the entertainment to them, but there was no feeling of isolation or mockery. Just friendly curiosity.

The people here may walk around with no shoes, live in one-room houses with patched roof and huddle outside around fires at night, but they are proud of their culture and their traditions. It is nice to feel included, welcomed, to their land. We find a willing teacher of their language and tradition in everyone. When Elizabeth, her brother Daniel and I were at the Lilongwe craft market, a vendor actually rescued me from the a swarm of sellers—the stall owners would literally surround you, shouting and negotiating prices over one another in you face. He pushed me into an old chair in front of his pile of works and taught me how to play a very popular stone board game of mathematics, attacking techniques and luck. We exchanged life stories and he even invited me to a Malawi Independence Day celebration where I could experience the traditional music and dances. Unfortunately, we did have time to linger in Lilongwe, which is quite far from Namitete. Our closest friends are the village kids who live in the nearby village of Namitondo. Even though they barely speak English, we are connected by our love of soccer and pictures. The kids would hang outside of St.Gabriel in the afternoon, waiting for us to play soccer with them at five. I have to admit that though I am an avid soccer fan, coming here is my first time playing soccer. Elizabeth and Daniel captain each team as they are college soccer athletes and I mainly cheer for everyone. Even to my eyes, the kids—ranging from 6 to 13 years old—are great runners and soccer players. They are unbelievablely fast and agile, sprinting with their bare feet hitting the barren ground. They are a goofy bunch; you can never get a nice picture with them. They always distort their faces at the last minute and then clamor to see themselves on camera. I am so happy to have met these kids. I can’t believe I can form these great friendships when we can barely exchange a few words.

The Carmelite nuns that run much of the hospital’s operations are wonderful. The Malawians nuns live in a separate convent from the original three Luxemburg nuns who have been here since the hospital’s beginning. We had been welcomed in both. Our visit to the Malawian nuns’ residency has been partially eye-opening. It was a nice complex with not elaborate, but comfortable and economical furnishings. We sat in the main dining room with the sisters and watched the televised special celebration of Malawian Independence. There, I had my first taste of a traditional Malawian meal, specially prepared by the nuns: nsema, fish and chicken. nsema, made from maize flour, is the main staple of Malawi. The maize flour is cooked into soft chunks—like bread—so that it can be eaten with hands, which I did for the most part of the meal. The nsema to me tasted bland with a slight bitter after-taste. However, it goes well with the fish and chicken. Z was impressed—as was I—that I ate the four-inch fish cooked whole with head, eyes and skin. It was not an unpleasant experience, just out of the ordinary for me. We took a tour around the covenant, including the sisters’ private chapel, their huge garden and livestock area. The sisters seem to farm everything they need: lettuce, papaya, potatoes, oranges, many native species we have never seen and a lot of corn for nsema. Everything was growing, healthy and huge. I admire the sisters’ productivity because farming is difficult because of the drastic change in seasons. I imagine the rainy season is the flooding type of rain because when we do have pretty heavy rain here—or what I would say heavy rain—the Malawians just call it showers. That and the prevalence of ditches spanning everywhere. Then when it is winter, there is no rain. For livestock, they breed rabbits for meat. White, fluffy, red-eye rabbits! Life here is so different. I can’t imagine a more unique place in the world.

Elizabeth was right: there is not place on earth that is like St.Gabriel’s Catholic Missionary Hospital. It is an amazing and inspiring place. For me, there are no words or no amount of words that can express what I love about this place.

The hospital is a community in itself. The ever-expanding hospital complex lies at the heart with red dirt roads spiraling outwards, lined with red-brick houses with flower beds and green lawns. The houses are not only for the nuns and guests, but also for the hospital workers and their families. The arrangement truly fosters a sense of community and teamwork amongst its members that allow the complex to operate as one team, one family. Everyone attends to their work diligently and most of all, cares about the hospital. There are always cleaners religiously mopping the floors, workers meticulously sweeping the incessantly falling leaves from the hospital grounds and doctors and nuns hurrying from place to place to meet the demands of hundreds of patients the hospital serves each day. It is amazing how self-sufficient the hospital is. The hospital funds a nearby primary school (grades 1-8) that all the kids in the surrounding villages attend. There is a library and carpenter furnishing shop next to the church. Fresh fruits and vegetables and other basic necessities are available in the market place of Namitondo, a literally three-minute walk from the hospital. Everything fits in this rural setting beset with poverty where I would have expected insanity in any other parts of the world.

St.Gabriel is such a wonderful model of what can be and still be accomplished through pure goodwill and generosity. The hospital is entirely run through donations; they do charge their patients but it is based on the “pay as you could” policy so that the patient can have control—not abuse– of his health. This year is actually the 50^th anniversary of the hospital so I had an opportunity to see its development through a series of compiled photographs. From a small house-like complex started by a few nuns from Luxemburg, the hospital has grown so much in recent years in the continuous attempt to offer the best possible care for the a-quarter million people it serves. The hospital has recently opened a huge pediatric ward with every bed equipped with mosquito netting (malaria is a serious concern here). A sprawling HIV clinic will be opening at the end of this year to meet the demands of the high prevalence rate in region (around 25%). In addition, the hospital is attacking malnutrition rampant in young children by improving its kitchen capacity to include four huge high-tech, boiler-like pots. The excellence of service and spirit has already drawn many international eyes; nursing students from Ireland and Belgium are with us this summer. A German orthopedic surgeon has also arrived and is piloting the improvement and training of the surgery department. I hope the hospital will continue to draw interest; it is a standing proof that an inefficient, professional hospital can function in a rural setting.

In the midst of everything, St.Garbiel continues to improve its services and increase its reach into the community. They have an extensive community health worker (CHW) program. In fact, we were fortunate to arrive at the time the new group of CHWs was being trained. We sat in one of their lessons. They cover a serious amount of material, from drugs to causes of fever. The notes of one trainee-one of Elizabeth’s many friends here—filled almost an entire notebook. We learned from head matron Chimera that the hospital is also expanding the program to include nurse practitioners in the villages, trained personnel who can take blood pressure and glucose level in the next three years. This is an amazing opportunity for the CHW screening kit that Elizabeth is piloting.

It is amazing to come here with Elizabeth. In fact, almost her entire family is here; we are living with her brother and her mother who works as one of only two physical therapists in Malawi. The Nesbit family is famous around the hospital; for the five summers the family has been coming here, they have always helped and donated to the hospital in whatever ways they could. Elizabeth’s older brother Joshua is a rock star here. Everywhere we go, we were asked “where is Joshua?” Joshua is in another part of Malawi but I am told I will have a chance to meet him, the person who pioneered Frontline SMS here. It is a software that enables large groups of people to send and receive text messages. More specifically for St.Gabriel, FrontlineSMS connects the cell phones of CHW to a central laptop at the hospital so that there is a fast, reliable communication network that doesn’t rely on internet. Elizabeth seems to know everyone around here; the village kids call her name on the streets and she has Malawian family friends whom her family visits. It makes assimilating into life here easy for me; making friends, establishing relationships are faster.

It definitely makes the incubator and bili-lights project start up faster. On the first day, when matron Chimera was giving us a tour of the hospital, we visited the neonatal ward. There were no incubators; the matron explained that she felt that they were too hard to maintain and she gave them away. In replacement, the kangaroo method is believed to be a much more suitable means of treating neonates; although this is true, the method is not hitting off well with the mothers as it greatly inconveniences the mother. In terms of jaundice phototherapy lights, there is one unit in the ward, but it requires that baby be placed at the provided unheated mat underneath the lights. As the ward temperature is not regulated (it is quite cold) and the baby must be stripped when being treated under the lights, the infant has a high likelihood of catching a cold or pneumonia when undergoing phototherapy. When the incubator and bili-lights were mentioned as cost-effective, alternative technologies, the matron is interested in a demonstration. There was almost no hesitation from her, whether it was because of the trust the Nesbit family has built or that the hospital is not directly below the government’s eyes. Either way, I was relieved because the projects can begin as soon as possible, which it did. We talked with the manager of the wood furnishing store already and they are helping us cut the pieces and assemble them this week.