Monday, June 8, 2015

In the Family way...


Shortly before I took off to teach a month and a half ago... my dog had just finished up her first cycle of being in heat.

Not fun.

I felt like a particularly hard-nosed warden as I locked her down day and night, chaining her to poles and chasing away her male suitors.

But I figured it would be worth it in the end not to have to deal with puppies.

Unfortunately, toward the end of her cycle --basically the last day or so-- I got lazy. I decided to let her out of her prison (aka: my house) and let her soak up the sun (while chained to my back porch).

I hadn't seen any suitors in a few days and thought her scent must have changed.

I was wrong.

After taking my eyes away from her for about 10 minutes, everything got errily quiet. So, I went out back to check on her.

Her chain had gotten stuck in my outside pipes and she was cornered by three male dogs. One was stuck with her... if you get my drift.

After almost a month of watching and worrying to avoid this very thing... I managed to mess it all up in 10 inattentive minutes.

Ugg.

Not sure if she could get pregnant on the last day of her cycle, I speculated on the probability of puppies with my neighbor and friend, Sarah.

As we debated the likelihood of it all, my dogs nipples changed.

I worried over them, insisting that she must be expecting. Sarah --always the rainbow to my rain-- suggested that I was overthinking it.

I didn't get to speculate on it too long, as I took the offer to teach a week or so later and left my dog in Sarah's care.

Every now and again, I'd return for a quick trip to Maforga. Initially, I didn't see much change in my dog's physique, so I started second guessing my initial pessimism.

However circumstances with my car prohibited me from returning for the last three weeks. By the time I got back, my dog was unquestionably 'in the family way'.

She is huge!

She waddles. She drools. She steals food from kids.

And have I mentioned.... she's HUGE!

Since I know the day she conceived, I can make the fair guess that she will deliver any day. If websites are to be believed, she will give birth on Wednesday June 10th.

Do EDDs on dogs vary as well? What happens if she goes post-dates? Do I have to induce her?

I will confess that I'm every bit the midwife to my dog as I am to women.

I rub her belly until she groans with pleasure and drools. I feed her every time she looks at me with those pathetically drowsy eyes until she falls into a food coma. And well... I basically let her be as cranky as she wants to be at any time day or night.

Just today, I was able to palpate one of her puppies. It kicked me (tehehe).

And I'm even contemplating shaving her belly so I can listen to their PHT (puppy heart tones).

This is going to be my first time dealing with puppies. I could use all the advice you can offer.


Thursday, May 28, 2015

Maternity Ward Observational


During my two week stay at the maternity ward as a clinical instructor, I had the opportunity to note some interesting cultural observations.

Day after day, I'd arrive at the maternity center with students in tow to find a number of first-time mothers in labour. Usually, the first-time mothers laboured the longest, while the multigravidas (aka: women pregnant for the second or more times) came much later in labour.

One G2 (aka: mother for the second time) came striding in, calm as the sea after a storm, only to discover she was fully dilated. She delivered (to my and my students dismay) while we were out of the room. It took her less than five minutes from beginning to end.

But labours like hers were not the norm. Most of the women who laboured and delivered there were first-time mothers-to-be. They arrived after the first or second contractions and then stayed until the baby was born.

For some this was quick. However more often than not, they were there for the long haul. One young girl (having more than likely braxton-hicks contractions) had arrived three days before. She had not had contractions in over two days, but she was not discharged nor did she seem interested in leaving. For the life of me, I am not sure why.

Several women came in at 1 or 2 cms dilated and chose to stay. The maternity ward was bustling but they did not seem to mind. They waddled around and watched as others delivered around them one by one.

When it was their turn to push, they were watched as well.

A lot of the first-time moms had hypertonic (aka: abnormally strong) contractions even though they were only 2 cms dilated.

After talking with the staff about it, I discovered that it was common for women to try and induce labour by drinking traditional herbs. These herbs cause painful and frequent contractions that don't always dilate the cervix. I saw similar things in the Philippines.

One nurse tsked their use of herbs, explaining that usually the ineffective contractions led to exhaustion, an inevitable referral to the hospital, and an (avoidable) cesarean for fetal distress. 

I also saw things done by the staff that caused me to pause.

One nurse sutured a woman up without using local anesthetic. Naturally the woman cried out in pain with each stitch. Meanwhile the nurse yelled and berated her for making so much noise. I didn't stay to watch. I couldn't.

One day while evaluating one of the labours, I noticed her family had purchased cytotec. When I asked her about it, she informed me the nurse had insisted she buy it. The nurse denied this since she was already well advanced in labour. However when I inquired the woman's family about it again later, they presented me with the prescription the nurse had given her. I never saw what the nurse did with those drugs but they were certainly not for the woman who purchased them.

I also saw a nurse be given a 'gift' of a capulana (a traditional cloth) at one point. She hurriedly rushed to put it away in her purse as the gift-giver went back to her friend in labour. I had been told that such 'gifts' were expected by the nursing staff but I confess I was still disappointed to see it.




Labor of Love May 2015

Wednesday, May 20, 2015

On the Road Again!

For those of you who prayed and gave.... thank you! My car is in working order again. It took 3 frustratingly long weeks but my new mechanic, Luis, has finally returned her in excellent condition.

In fact, I don't think she's ever been working so well!

He had to put on a new engine head (as the one that I got fixed in Zimbabwe last year was in fact cracked) and all the valves, gaskets, and what-nots that usually go into such things.

Plus, he fixed my emergency brake (which was loose), replaced my starter (which was finicky), put in a new clutch (which was smashed to bits), and fixed the door handle on my trunk (which had been broken while I was on furlough)!

The man is magic. Magic! I say.

My engine now purrs as she bounces down the road.

Mind you, I still need new tires... but other than that, the car is better than ever.

Thank you for your precious prayers!


Wednesday, May 13, 2015

Stitches?


The third birth I observed seemed normal enough to begin with. The mother was 27 years old and expecting her second child.

When we arrived, her contractions were strong and frequent but she seemed to be handling them well. Within no time, her water broke displaying a yellowish puddle of meconium stained fluid.

The nurse set up the room for the birth (which means she got a bed pan, some non-sterile gauze, and a birth kit and placed it at the foot of the bed). The bed pan was slipped under the mother's bottom and she was told to push.

She pushed for only 5 minutes for the head to be born. But then the nurse reached in and wrenched him out. The mother stayed quiet while the nurse literally pushed and pulled and twisted and turned his little body every which way imaginable.

Two minutes later, the nurse lifted his body free of the mother with a gush of more mec-stained fluid.

The nurse then injected her with oxytocin to precipitate the placental detachment, then started massaging her uterus.

She massaged and pushed on it externally until 4 minutes postpartum it popped out in a gush of clots and blood.

She placed the boy in his mother's arms and evaluated her tear.

There was a tear but it was not deep. At most i would have put it at a shallow 2nd degree. However, as the nurse considered it, I overheard her worry how she was 'out of stock'.

I thought nothing of it, until a few minutes later I watched her suture her up with 3-0 acrylic (aka: non-absorbable) suture material.

She placed interrupted stitch after interrupted stitch, burying the deeper stitched beneath the more shallow ones.

My jaw dropped in surprise and my legs snapped closed in horror... but I didn't say anything. How could I?

We were guests there. I could not make those kind of calls... nor could I criticize them in their work. But I confess, I worry still what those buried sutures might do. Perhaps her body just rejected them and the string fell out as they healed.

That is my hope at least.

Monday, May 11, 2015

Fit To Be Tied.

The next birth happened a day or so later.

The young mother-to-be was alone but apparently unconcerned by this fact. Not all of the labours have companions.

So as she laboured, I taught the students how to evaluate her contractions and take her history. She was 20 years old and expecting her first child.

She readily admitted to taking traditional herbs to prepare her body for birth... and even to start her labour.

Since her contractions were strong and frequent, the nurse decided to do a vaginal exam at 10 am. The nurse was VERY aggressive during this exam, manually dilating her cervix despite the patient's vocal protestations.

Afterward the nurse informed us she was 90% effaced but only 6 cm dilated. But after such forceful manipulation of the cervix, I did not think it true for long.

Sure enough, an hour later her water broke and she immediately got pushy.

In fact, there was no stopping her. So we called for the nurse. 

The young mother was already fully dilated and wanting to push. The nurse tried to get her to focus and push effectively but she would have none of it.

All she wanted to do was scream. 

One scream was so piercing and so long, it could have shattered glass.

After some negotiation, we convinced her that screaming like that was not actually helping. In her defense, she did really try to push. But each time she did, she would close her legs and withdraw.

It was going no where. 

The nurse was not pleased and she argued with her.

She then tried to push again but ended up kicking the nurse and swatting her hands away.

The nurse was even less pleased with this behavior. 

After more negotiating, the young mother confessed that she needed help controlling herself and requested that two of the male medical students hold her down while she pushed.

Yes. She wanted them to forcibly hold her down so she would not hit or kick the nurse.

So they did.

Mind you, they seemed more than a bit surprised by this. I don't think either one of them woke that morning thinking that they'd have to tackle a pregnant woman while she pushed her baby out. But you know... some days are surprising like that.

I soon found myself out of my depths and stepped away from the melee to watch at the foot of the bed. The remaining two students shuffled a step closer to me with each new scream. One (who plans on being an obstetrician) was wide-eyed and mesmerized by the beauty of it all. The other (who is unlikely to choose obstetrics as a specialty) kept hiding her eyes and furtively glancing my way for assurances that the woman was not in fact dying.

Meanwhile the young mother continued to scream and abuse the staff while pushing. The nurse, more than likely frustrated with the abuse, decided to perform aggressive perineal stretching. The baby was born quickly but caused a significant 2nd degree tear in the process.

The placenta was pulled from her body within minutes of the birth with strong cord traction. It was so strong in fact, that the cord snapped, squirting blood all over the foot of the bed.

The nurse decided to suture the tear before presenting the baby to the mother. The young mother screamed and fought the sutures just about as much as she did the birth, despite being anesthetized.

When the nurse finished up the stitches, she reached down for the baby's ankles, lifted her high in the air and presented her genitals for the mother to see.

The young mother whispered, 'a girl' to herself and smiled.

Then the baby was taken off to be wrapped and weighed.

Friday, May 8, 2015

Normal?

Her contractions were strong and frequent when I first met her. She lay on the bed and her mother held her hand.

The pain contorted her face and forced the occasional groan, but she didn't seem to notice it much. For the most part, she was surprisingly quiet.

So quiet in fact, that I didn't think she was even close.

As a 17 year old G1 (aka: primigravida or woman pregnant for the first time), I expected things to go a little slower. But her body had other plans.

Shortly after we arrived, her waters broke and she started getting grunty. One of the students informed the head nurse, who started setting up the room.

She started pushing before the nurse was ready, so I encouraged her to breathe through contractions and taught her how to push effectively.

The grandmother, looking a mixture of exhausted-relief, excused herself to the corner of the room and said nothing. Absolutely nothing.

The mother pushed effectively despite the five extra medical student faces huddled around her bed. She didn't seem to notice or care in all the pain.

The nurse on duty expedited the birth by doing perineal stretching and the mother remained silent. She pushed only a handful of times before the head was born. The nurse didn't wait for the next contraction, she just reached inside and wrenched the shoulders free. Again, the mother made no noise.

The baby was out less than a minute when the cord was cut. She too made not a sound. Just like her mama.

The nurse grabbed the child by both feet and swung her in the air, presenting her upside down for the mother to see. The mother smiled when she saw it was a girl, then dropped her head back on the bed in a rush of exhaustion.

The nurse lay the child on her breast and it mewed quietly.

Within 3 minutes after the birth, the nurse aggressively massaged the mother's uterus and applied traction on the cord. The placenta wasn't budging. She forced it harder and massaged even more aggressively.

This continued until the nurse found herself with a torn placenta (only 5 minutes postpartum) and decided to do a manual extraction. Reaching her right hand in up to her elbow, the nurse extracted chunk after chunk of the placenta from the uterine wall. Each time she reached in, she came out with chunks, clots and membranes.

The mother made not a sound. 

Afterward, the nurse reached in repeatedly with non-sterile gauze to evacuate the uterus and vaginal canal of any remaining blood. But still the young, new mother remained silent.

Inside, I screamed for her. Inside, I cried out in pain.

For her.

How she remained so stoic... so quiet, I'm still not sure.

As I looked through the nurses' bloodied hands, several baffled expressions caught my eye. "What must these medical students be thinking?"

For many of them, this was their very first experience with birth. I shuddered to think that this was considered 'normal' in Mozambique.

Perhaps... it is normal. 

Wednesday, May 6, 2015

Multiparity


The last two weeks of May involved teaching at a maternity ward downtown. My job was to help introduce fourth year medical students to 'normal' birth. Much of our time was spent labour watching, timing contractions, evaluating fetal heart tones, and palpating fetal positions. However, we also got to do a number of newborn exams and assist in a few births.

One day we arrived to find a young woman occupying one of the labour beds. Naturally, we assumed she was pregnant (as her fundal height was marked), so I told two of the students to time her contractions. Ten minutes later when I came back to see how things were going, I was informed she was not in labour and that her babies were in the other room.

So I instructed them to get her obstetrical history instead.


The new mother explained that she was a 20-years-old mother of six. Earlier that day, she had delivered twins at home. She came to the maternity ward for the birth certificate but did not seem very interested in any other service. Since her babies (a boy and a girl) were cold and covered in sand, the nursing staff had taken them for evaluation and placed them in a warmer.

The mother explained that she had delivered her first child at the age of 11 and that her previous four pregnancies were simple. This was her first set of twins, however. 

She didn't want to talk much about the particulars, so we didn't press her for more information. Although I know 11-year-olds can get pregnant, my heart hurts to think that this mother has so many mouths to feed and so much responsibility...  at such a young age.

What were you doing at the age of 20?


Monday, May 4, 2015

Teaching

As I mentioned previously... during the months of April and May, I was invited to be a clinical instructor for a medical school in a neighboring city. The people I met and the opportunities this experience afforded me were equally wonderful and heartbreaking.

The first four weeks, I worked with nursing students doing clinical rotations in a busy hospital. The school gave me a white coat, a pen, and pointed me to the various departments. I was working in the pediatric department and the malnutrition center.

Needless to say, what I saw was...

Stressful: Each morning I had to rush from where I was staying (my commute was anywhere from 40 to 90 mins one-way) to get to the hospital in time for roll call. The hospital was crowded. The needs were overwhelming.

Disconcerting: The manner of teaching was very different from my own (educational) experience. I felt like I was wading eyebrow-deep in murky waters for the first few days. Every day brought new challenges with no cultural insider to ask if I was making a fool of myself or standing tall. Sigh.

Heartbreaking: No one forgets the gaunt and wasted face of a 8 year old boy dying of AIDS. It's hard to silence the wails of a mother who just watched her two year old die.

Fascinating: One day a 4 day old neonate was brought in to determine the sex. The genitals were ambiguous. After the examination the doctor explained the mother had an hermaphrodite. The news was not well received.

Overall, my time there was...

Exhausting: Most days turned out to be 10 to 12 hr days. Speaking all day in Portuguese was a challenge as well... mentally and physically.

Expensive: Though friends let me stay with them for free, the public transport was either cheap or inconvenient. Getting back and forth from work took an hour and a half in the morning if I went with 'cheap' (costing less than a dollar). But if I needed to get there quickly (30 minutes or so), it cost 8 dollars. Sigh.

Insightful: After two years of stories about policies and practices in governmental hospitals, I was finally able to see first hand that they are true. I saw corruption, neglect, abuse, and incompetence. But I also saw many who did not fit the mold and strived to do well.

Blessed: I was able to make lots of new friends and learn how the medical system works in this country. Often I was impressed by the caliber of medical professionals in this country despite the obstacles they must face to care for their patients.




Thursday, April 30, 2015

Overheated: The Saga Continues

Again, please forgive me for this rant. I feel like I’m complaining all the time. I probably am though. As I have more bad (expensive) news to share.

My car... the one that overheated last fall and got a complete new engine... started having troubles again a few weeks back.

My local mechanics (aka: my team members) poked and prodded and said all was good to drive. I was not so sure.

I took it on short trips for the day and it appeared to be fine. But apparently when I decided to come to Beira to start teaching, everything heated up a notch.

The three hour trip turned out to be too much for my car. It overheated.

But oddly, there was no mad cloud of steam and the engine did not freeze. It just got hot and I stopped to cool it off and eventually add more water.

Delayed but not stuck (Praise God!), I eventually made my destination and started volunteering. But almost immediately, it was using more water and oil and acting all hot and bothered.

So I asked around for a good mechanic. That’s how I met Luis.

Luis is Zimbabwean of Indian descent. Nice guy from all appearances. He took a few hours to check ‘Hot and Bothered’ out. The diagnosis was not pleasant.

Though he won’t know for sure until he takes the engine out --Yep. The engine must come out. He says I got really bad work done in Zimbabwe last year. The hack job they did has to be re-done.

All of it.

The price tag is likely to be the same.

This news has been just one more thing in a series of bad this week (i.e. lost paperwork, roofing delays, team drama, etc.). Fortunately, it has not got me shaking in my boots.

Though pressed on every side, I know I’m never abandoned. I feel His presence so intensely. I feel so close to birthing this clinic.

So. Very. Close.

The enemy is shaking in his boots. If he thinks that by frustrating my papers and breaking my car that I’ll somehow turn tail and leave, than he’s a mighty big idiot.

His tactics are base, desperate and ultimately powerless in the face of God’s divine will.

He will fail.

Please pray for me (and the team here at Maforga) to daily find ways to become more than conquerors.

Some battle scars are still fresh. To be honest... some are actively bleeding. But I turn to my Healer for these wounds to be bound up and make whole.

May I come out of this battle stronger and more suited for the next task at hand.

Oh... that His people would PRAY.

Labor of Love: April 2015

Wednesday, April 29, 2015

Lost in Maputo-land.

I’m not sure how to update you all on my equivalencia paperwork without coming off as hostile, morose, or defeated. So I’ll try to stick to the facts.

Fact number one. I got promises for immediate action (meaning an answer in less than one week) from the director of education in Maputo.... 5 weeks ago.

Fact number two. Last week, I got a call that there was an answer to my paperwork but since it was a Friday, no one could be bothered to open the envelop and read those results over the phone. My friend in Maputo would have to show up in person on Monday.

Fact number three. My friend was busy so he went in on Tuesday. While there he was told that the department of education had LOST my most recent application. We’d have to resubmit everything. --everything since January that is. That equates to 5 months of wasted time.

Fact number four. I’m really disappointed, somewhat angry, and overall unimpressed.

How does a country, that has lost or misdirected my application four times in almost two years, get anything done?

Seriously, are you kidding me?!

Please pray as this next round of paperwork should be submitted next week. Pray for supernatural results.

This is beyond ridiculous.

Tuesday, April 28, 2015

Roof Going On...


Your prayers for the roofing material were heard. Last week I got the call that they had arrived and were ready for pick-up. I arranged for my friend to cart them out to our community but the following day... I was informed that not all of them had been picked up. I had to pay (again) for the remaining two roofing sheets to be delivered before I could start thinking about tearing things up.

The thing is... since the roofing material took 4 1/2 weeks longer than expected to arrive, I was no longer able to oversee the project. (I had already committed myself to teach for 6 weeks at a medical university several hours drive away.) So I asked a team member to do it for me.

Thankfully, he agreed.

This week, the old roof was torn off and the new roof is going on! Yeah!!!

Though I’ve missed the process, it is probably for the best. I’m discovering that I’m too nit-picky when it comes to construction in this country.

For example on the first day of construction, when my team member told me that a quarter of the roof had been torn off but they still hadn’t purchased the nails to put the new roofing on, I almost started hyperventilating.

Not good.

After first reassuring myself that the sky above was a perfect cerulean blue, I told him that it was probably best not to know the details. We’ve had too much rain in the last few weeks for me to comfortably tear off the clinic roof... and leave it off.

Even for a day.

Since then, I’ve heard nothing but good things. Apparently, the old roof has come off completely... and the new roof is more or less on.

A team member is taking pictures. I’ll be sure to add them as soon as I can.

Thank you for your prayers. And thank you to all those who have given to make this new roof possible! You all are awesome!

Sunday, April 19, 2015

More Papers Than Sense

Last year after getting the license to open the clinic, I headed off to Beira with a spring in my step to buy supplies for the clinic. Beira is the best place to buy medicines since it’s a coastal city and there are a number of pharmaceutical companies that import medicines directly to the port. 

When I approached them for catalogs and supply lists, they told me with tight-lipped condescending smiles they could only sell them to me if I had an AVARA.

Never having heard of this document before, I returned to Maforga empty handed. I asked around for help in obtaining it and got a LOT of conflicting information. Once the dust settled and I was able to filter though yet ANOTHER set of paperwork requirements, things got even more confusing.

I won’t bore you with the details. But I will share that I’ve been working on the process for over 9 months and I don’t feel even one step closer.

After spending lots of money getting the building inspected and registered, I was informed that my efforts were wasted. You see... I had been seeking a way to establish a pharmaceutical license/AVARA for the clinic. That way I could buy the medicines in Beira and then provide them to the community.

But I should have done my homework better.

The Mozambican laws prohibit a private clinic from also owning a private pharmacy. And even though the clinic is a charity/non-profit clinic, there is no way to have a non-profit pharmacy.

So... I was denied that route.

The only route that remains is to get the AVARA for the clinic. This is still a possibility and it might permit me to buy some medicines. I’m not sure. But to complete the process, I must wait on others.

So I wait.

And I pray.

Please pray with me.

Thanks.

Saturday, April 18, 2015

Water Anyone?

As I alluded to in my earlier posts, our water situation at Maforga still has a few leaks in the system.

Metaphorically speaking, of course.

Last fall after almost a year of no and/or very poor water supply, we were able to reconnect the water for the orphans. This dearly improved the quality of life on a whole. But if memory serves me right, that fix appeared to be electrical, resulting from a faulty pump.

If you recall, that was also around the time I was pushing for the water tank at the clinic to be completed. After months of delays, a wonderful short-term team of construction workers in connection with local workers finished the water tower and installed the tank.

However due to continued water shortages, I was not able to test out the tank until I returned from furlough in January. Only then did I learn that the water supply was not good enough to fill it as well as provide for the orphans.

Fortunately, God had foreseen this problem and had already provided through some very generous donors enough money to dig another well.

However after some months of unforeseeable delays, Roy (the director of Maforga Mission) was finally able to contract the well digging company to come out last February.

I’m told the first place they dug was no good. They hit granite. We didn’t have enough money to pay them to dig again and again, so Roy asked them to re-dig an unused well instead.

Though they did re-dig it, they then did not have the right casing or pipes or even a pump to fit it and so it sits waiting.

The un-used well, I’m told by Roy, was abandoned after having to repeatedly repair the pump due to sand clogging the system. He expressed a hope that with new casings and a better pump it could be much better and the water would be diverted directly to the clinic. This would avoid having to share the water with the orphans.

The problem is... no one seems to have the right size of pump for this kind of casing. He must look for it in S. Africa. He tells me he intends to get it next time he goes.

I’m sorry I don’t have better information than that. Please pray that the parts come together for the well to be useful or for us to find another way to resolve the water issue.
Currently, there is no water at all to the clinic and I cannot open it without it.

Thank you for your prayers.

Overheated.

So on Monday, one of the team borrowed my car. After a day of running errands, he returned with news that it appeared to be overheating.

Not good.

I took a look at it, and sure enough. It was hot and bothered.

The water boiled furiously out the hoses. The engine strained and sizzled each time it started. And even the tires appeared to be constantly losing air.

Sigh.

I tried a little bit of this... and a little bit of that; I asked you all to pray; And then finally, on day three of the confusion, it became clear.

There was a hose problem.

Another team member lent me his hose to see if it was something so simple. And now it works like a charm.

Please pray for me to know how to take care of this precious ministry tool. Getting from point A to point B is more important than I can express. Everything hinges on transportation in a place as remote as this.

Thanks.

Friday, April 17, 2015

Invitation to Teach

You’ll be happy to know my mud-encrusted toe nails are bright and shiny again. It’s amazing what a tepid bucket bath can do for the spirits!

I don’t remember ever going so long without a shower --when one was available, that is-- and I can only attribute it to my muddled mind and burdened heart. I forget to do things like eat and shower when I’m tied up emotionally.

To say, I’ve had a lot on my mind lately would be inaccurate. ‘A lot’ indicates more than the usual load. What word describes more than ‘a lot’?

A ton? A mountainous weight? Atlas’ burden?

No. That’s not accurate either. Because it’s the number, not the weight, of the issues that trouble me most these days.

As I sit and type, I’m reminded of one of my dad’s favorite sayings: ‘If it’s not one thing, it’s another.’

So yesterday I shared about one of the things. In the days to come, I’ll be sharing even more. I’m finding it’s remarkably helpful to write them down.

The simple task of typing them out reminds me of catching butterflies. I bounce after each thought in my head, trap it with a gossamer net, and gently pull it free. As I examen the specimen, I marvel at its intricate markings.

So delicate. So beautiful. So distracting.

I lay this butterfly aside and it stays... remarkably.

And I pick up my net for the next.

So... as every good story needs a beginning. That is where I’ll start. Here goes...

While in Maputo for my paperwork a few weeks back, I stayed in a missionary guesthouse where I met a missionary couple from Beira. They were leaving to come back North the same day as I was and I asked to hitch a ride. They kindly obliged.

This lovely couple shared their stories with me as we traveled and we told them of my plans as well. We discovered that we had similar interests.

They work with the youth near a Catholic medical school in Beira. Many of their Bible study students attend the school and over the years they have made many friends there. They offered to connect me with their friends.

When they dropped me off, I promised to stay in touch and come visit at the first opportunity. I wanted to meet with the school directors to see if they would send nursing or medical students as volunteers once the clinic opened.

About a week later, I was able to arrange the trip out there and I called them up. They generously invited me to stay the night. However the day I was to head out, I got delayed and called them to say I’d be running a few hours late.

-- “Hi, B. So sorry but I won’t make it for lunch,” I explain by phone. “I’ll see you later in the evening. I had an emergency to take care of this morning... and I’m delayed”.
-- “Oh, dear. But we arranged for you to have a meeting with school director at 2pm,” she worried aloud. 
-- “What?” I stuttered. “Um.... thanks. But had I known I would have tried harder to be there. I’m three hours away.... I don’t think I can make it in time.”
-- “Oh, dear. But they can’t meet tomorrow....”
-- “I’ll try to come now. Please see if you can push it back a bit.”
-- “Okay. See you soon.”

As I made a mad dash back home to pack and raced off down the road, I couldn’t help but be simultaneously confused, irritated, and thankful.

  • Confused.... because I had no idea about the meeting and was surprised. 
  • Irritated... because I was now late for a meeting I never knew was happening and I might not make it in time.
  • Thankful... because they had made such a sweet effort to bless me.

I was three hours away. The meeting was to start in three hours exactly. By the grace of God... I made it.

I had just enough time to park, meet up with my friends, then hurry off to the medical school. They tried to catch me up as we walked.

We arrived and I shook Dr. E’s hand with a smile.

-- “Hi”, he smiled back. ‘We are excited to have you here today... but before we go any further we need to know what kind of midwife you are... and whether or not you expect to be paid?”

I shared my experience with him a bit confused and denied any interest in payment. In my head, why would they pay me to send me interns? I shrugged it off and let him lead the conversation.

He was pleased to know that I didn’t need payment and offered to introduce me to the woman in charge of the nursing department.

I confess, the meeting was one big confusion. There were three languages being spoken simultaneously and questions that didn’t connect with my expectations.

Forty minutes later, I was sitting around my friend’s dining table sipping coffee and trying to make sense of it all. As I strung all the questions together in a play-by-play evaluation, it occurred to me that the meeting felt more like a job interview than anything else.

So I asked the obvious.
-- “Was that a job interview?”
-- “Yes, it was. What do you mean...” he asked in confusion.
-- “But I thought the meeting was so I could ask for volunteers... not be one,” I explained.

This revelation brought on more confusion, prayers, and phone calls of explanation. I called Dr. E to apologize for the miscommunication. He didn’t seem to mind at all and insisted that they could really use volunteers.

Although I no longer saw the reason for another meeting scheduled the next morning, he didn’t want to cancel it. Rather he asked me to come and hear them out about what volunteering would be like.

The next morning I went and met several doctors and directors. They told me they had teaching modules and I could be a huge help in two modules in particular and that I’d be useful as a clinical instructor for both the nursing and medical department.

If I agreed, I’d be teaching students three days a week in the morning and my afternoons could be spent working in their HIV department where I could learn the country’s protocols. This is a HUGE answer to prayer. I know I’m hopelessly uninformed on HIV protocols and treatment options (there was almost no HIV in S. Sudan), but I wasn’t sure how I’d be able to learn them... until now.

Needless to say, I told them I’d pray about it and get back to them.

That was a week ago.

Since then, I’ve talked to my director here at Maforga and he agrees it’s a God-opportunity. Moreover, God has provided a place for me to stay while in Beira and the right uniform. I’m only missing white nursing shoes.

If all goes well, I’ll tentatively start next week. However, that depends on my car working. Since my return from Beira, it has started overheating.

I’m hopefully getting it fixed today. Pray that it can be sorted quickly and that I can volunteer without any issues. I’m eager to see what God has planned for this new adventure.

A Roof-to-be

A Roof-to-be


Last year I planned to put a new roof on the clinic. But before I could arrange the details, my car engine exploded. Resolving my engine problems took precedence and then I had to leave for furlough.

By the time I had returned, the rainy season had made getting a new roof on impracticable as the rain rarely let up long enough to give me hope.

Well, now the rainy season is passed. Mostly.

In anticipation of this drier season, I got the funds together, checked around for the best prices, and ordered the materials. I was informed, at that time, that it would take 10 days at the most.

It has been almost a month.

I went in to the roofing supplier with questions and was told the equipment that cuts the metal roofing tiles is broken. All their orders are backlogged.

They could not promise or even estimate how long it would take to get the roofing.

Foolishly, I pushed and prodded for a time frame. They hedged and made empty promises.

So I wait.

Please pray that the supplies will arrive soon and that I can arrange to get the roof on in the next month or so.

I’m told it’s a week long process.

Only time will tell.

Please pray.

Thursday, April 16, 2015

Equivalencia Update

You know it’s an off week when you look down at your mud stained feet and wonder when you took your last shower.

Yes. You read that correctly. And when I say shower... I really mean bucket bath.

In the midst of my feet-inspired reverie this morning, mini flashes of strange and various adventures this week confused my counting and I had to start again.

Finally I determinde --with much self-incriminating horror-- that it has been 7 days.

One week since I showered.

Oh the shame!

It’s at times like this that I’m thankful God hasn’t married me off. Who would share a bed with such a stinker?!

So as I stop to type this out, imagine my grimy toe nails and greasy hair and laugh with me.

I have much to share.

In fact, I have so much to share. I’m going to do it in mini segments because, honestly, who has time to read diatribes on Mozambican corruption or shady mechanics?

I will start at the beginning though. The question is... which beginning?

The Maputo Adventure (and all that came after)

In my most recent newsletter I told you how I went to Maputo to talk to the US ambassador and various heads of departments at the Ministry of Education and Health. I won’t belabor those points again but I will add what has happened since.

The consulate staff has corresponded with me and told me basically their hands are tied. They can (and have) tried to address the delays in my equivalencia process on a more systemic level, but to no avail. They are even willing to make phone calls for me if and when it seems necessary. However, the extent of their influence is limited at best.

I believe them.

Moreover shortly after my visit to Maputo, the Ministry of Education director promised to expedite things (according to my helper in Maputo) but no concrete evidence to this fact has surfaced. She promised to have results by the end of the week. It’s been 2 1/2 weeks since then.

The cogs of bureaucracy move slowly here... if they move at all.

So the long of the short of it is... I must wait and pray. So, I wait and I pray.

The locals are chomping at the bit to see the clinic open. Eyes are on me. Not a day goes by that one of the workers doesn't ask me ‘how long?’.

Can I blame them?

I’ve been encouraged by some on my team to ‘just open it’ and to ‘forget getting government approval’. I’ve been told that the ‘law of love supersedes the laws of man’ and I’m commanded to just start healing people.

How can I argue with that?

Except... except... except, the Bible tells us to abide by the laws of the land. If we don’t abide by them we disgrace God and bring shame to His name.

How do I reconcile the two?

I tell my would-be encouragers that if I practice medicine without a license I can be arrested. No one seems to believe me. No one really thinks I’ll be thrown in prison or kicked out the country for ‘doing good’. But who wants to risk it?

What kind of Christian would I be to openly defy the government on such an important issue? Why put myself in such a predicament, especially in such a litigious society, so I can have the pleasure of handing out medicines?

Yes, the law of love supersedes the laws of man. But am I qualified to pick and chose which laws to obey?

But we are not talking about being forbidden to speak about Jesus or pray in His name. I’m not being forbidden to preach... I’m being told they need to vet me before I dole out malaria meds and catch bambinos.

To me... these are quite different circumstances.

Moreover, I must explain that my equivalencia is not the only thing holding up the clinic’s opening.

The three main issues blocking my way at the moment are:
  • a new clinic roof is needed but delayed.
  • there is currently no water to the clinic and there is no way to determine how long it will be to resolve the problem.
  • the AVARA document process is stuck. This is the document which allows me to buy medicines in bulk and for discounted prices.

Other issues come into play (such as my car is broken again!). But I won’t rant about that at this time. I will, however, promise to write about them all individually and in more detail in the days to come.

But please know... I’m tired and discouraged. I feel like a failure and daily want to give up. I could be inches from my destination... or I could be a million miles away. I cannot know for sure or clearly see what is next. Pray for me.

Please.

Sunday, July 20, 2014

Maputo re-bound (or my journey home)

I’ve been putting off writing this last leg of my journey for two reasons.
         One: I didn’t want to sound like a whiner.
         And two: It was so traumatic... I’d mostly blocked it out.

It all started innocently enough.

I had arranged to stay at the Maputo guest house throughout the day, even though I was checked out. I drank coffee, caught up on some correspondence, and traipsed off to the artisanal market down the road to see if I could find some treasures.

I did.

However, the most important trip that morning was getting (all the way across town) to purchase my bus ticket home. I’d done it so often, it’d become routine.

Depending on traffic and the competition stuffing themselves into the public transportation (aka: chapas), the trip can take 40 minutes... or 2 hours.

That morning it took 2 hours, a near knock-down-drag-out with an overly aggressive woman in tight jeans and even tighter braids, and about 45 cents.
    -- Yeah. Public transport is pretty cheap here!

The bus depot sits just outside the city limits on a round-about. It’s gated and always crawling with travelers, ticket masters, and merchants. The buses wait under small overhangs until departure. Small panels indicating their final destination are perched on the dashboard.

The bus for Chimoio sat in its usual spot. As I approached, the ticket master and driver both smiled. In Chimoio, I have to buy the tickets directly from them. But in Maputo there is an official stall. I know this... but avoided the stall until I could get a better look at the bus and drivers.

I had already decided that if it was the last crew I’d hang out in Maputo a day or two longer and spare myself the heartburn.

Fortunately, they were not the last crew. In fact, I knew them and they knew me.
-- “Hola!” the ticket master said in greeting, “Your going to Chimoio, right?”
-- “Yes." I smiled in greeting. "How are you?”
-- “Fine. Thanks,” he smiled back and reached out his hand. “It’s been a while. How are things at the clinic?”
I reached back to shake his hand. This was Joseph. I’d traveled with his crew many times before, and he was always interested to hear any updates on the clinic.

I tried not to grimace as I explained things were still not open and updated him on the latest paperwork saga. He shook his head knowingly at my reports of delays, frustration, and general difficulty.
-- “E-pah!” he said sympathetically. “These officials are a mess!”
I agreed with him, but didn’t trust myself to say more. Instead, I turned the conversation back the trip home.

-- “I’m so glad it’s you guys,” I started, “You would not believe the trouble we had coming down earlier this week.” I complained to him briefly about the endless delays and he nodded knowingly.
I continued on. “I’m so glad to see this is an express bus. Will we be arriving on time?”
-- “Oh, yes. It’s an express bus....” I could see he had more to say, but didn’t. So I picked up the string of conversation and said, “Okay then. I’ll go buy my ticket and see you guys tonight.”
He waved goodbye and I promised to fill him in on more of the details when I returned.

I bought my ticket then hurried back to the guest house for my things.

When the day was done and dinner at the guesthouse was winding down, I gathered my bag and made my way back to catch another chapa. Two ladies who work at the guesthouse kindly walked me to the chapa stop, prayed for safe travels, and waved goodbye through the tinted glass.
    -- What dears! Little did I know how much I needed those prayers.

But even at 9 p.m., the chapas are quite full. Men in wrinkled suits and woman in 2 inch heels doze on the commute home. Those unfortunates who have to stand in the aisles, dive and dip each time the bus screeches to a halt or revs off in a cloud of exhaust fumes.

I stood most of the way, clutching my bag in one hand and a metal rail in the other. People pushed and elbowed their way past as they loaded and unloaded, but eventually a seat opened up. I sat in relief and tried not to doze. It was past my bedtime and my stop was just a few minutes away.

This time when I got off the bus, the fruit stands and street vendors were packed away for the night. Only the road was choked with commuters; the sidewalks were clear. Weary travelers, carting bundles on their heads and suitcases under their arms, zigzagged past.

I joined the march and soon found my way back to the bus. I was not the first to arrive. One man was already asleep opposite my seat. He leaned over his bags protectively, snoring lightly.

I settled in for the night and tried to doze as well. The flood lamps were not making it easy --nor did the chatter from the vendors just outside my window.

Piles of water bottles, soda cans, and bread rolls were for sale. Woman stacking oranges in bundles of three, adjusted their babies on their backs and called to passers-by to come buy from them. Men smoked, joked, and watched the steady flow of travelers come and go.

Somewhere between the noisy mother of two bumping her way in to the bus at 10 p.m. and the raucous laughter of the smokers below my window, I slept. But I didn’t sleep long.

At 3:30 a.m. exactly we drove off. By then anyone who was not on the bus was left behind. Comforted that the journey had officially began, I finally slept deeply.

I didn’t wake again until about 8, when the screeching brakes informed me we had stopped. I lifted the blanket off my head and noticed sunlight. Lots of it.

A dozen men were already outside relieving themselves. Women and children were further down. The colors of cloth tied in their hair made them look like flowers in the yellowing grass below.

I closed my eyes again and slept.

Hunger woke me up the next time. I munched on snacks and asked the man next to me how far we’d come. He didn’t seem to know... or care.

Rested by this time, I decided to read a bit and watch the coconut trees pass. Hours flew by in a blur of villages and brightly colored kids playing on the road.

By 11 am, we’d made it to Xai-Xai where the mainline buses always stop for food.

I remember thinking we were late in arriving... but not overly concerned. I was hungry and exited in the mass of flesh. I was one of the first to order a chicken to-go plate and a juice.

I stretched a bit before making my way back on the bus. Ten minutes later we were on the road again.

The afternoon light beat down on me as we rode north. A new man had taken the seat beside me after the first reached his destination. This man was headed to Chimoio too and asked me questions... but didn’t flirt.
        --Whew!

I knew from previous trips that we were running late. The convoy (or police escort through rebel territory) took off between 2 and 3 pm when heading North. I started worrying my lip at the thought of missing it. Why didn’t anyone else seem concerned?

When 2 o-clock arrived and we were still miles off, I considered asking the driver for an update. But I hesitated. Pressuring them never worked. So I waited, read, and prayed.

We didn’t arrive to Rio Save (aka: the start of the Convoy) until after 4 pm. We’d missed it by hours. Why?

I waited until the bus completely unloaded before I approached the driver.
-- “Did we miss the convoy?” I asked confused.
-- “Yes,” he admitted.
-- “But why didn’t we drive faster? Couldn’t we have made it in time?”
He laughed at my confusion then explain that things had changed since the last time I had traveled with them. There was only one convoy a day... and it was at 11 am. We would have never made it in time. This is why he didn’t bother rushing. Then he explained that the afternoon convoy was no longer available.

As he spoke, it finally occurred to me that I’d be sleeping on the bus again and there’d be no North-bound progress until well into the following morning.
-- “How long has it been like this,” I asked, finally understanding.
-- “Oh... about two months. Since the last attacks.”
I did the mental math and realized that my last trip to Maputo was right before the attacks. I had no way of knowing it’d changed. It was probably best that way... as I wouldn’t have bothered to come if I’d known.

At this point I decided the best thing to do was to eat, charge my electronics in the nearby restaurant, and settle in for another night on the bus. Little did I know what that night would be like.

Sadly, I have nothing good to say about the things I was forced to listen to that night. Let me just say, it involved loud, drunk men, boisterous and calloused woman, and demanding children trying to make themselves heard over the raunchy repartee. They were unsuccessful, albeit persistent.

By 11 pm I was ready to start knocking heads but could think of no way to get them to quite down. I briefly contemplated stealing one of the soldiers AK-47s and marching them off the cluttered bus. Would I have to blind fold them before I subjected them to the firing squad?

By midnight, I was exhausted but 95% of the bus had settled by then. Only the most determined flirts and raunchiest drunkards bellowed on. At this point, I turned to the guy next to me and asked, “How do we get them to be quiet?” He was Mozambican. He had to know how.
-- “I’m sorry... I don’t know what to do,” he confessed. “Perhaps when the bus driver comes back....”
Unfortunately, I knew that the bus driver had rented a room for the night and was not coming back until the morning. That was a no-go.
-- “Humph!” I complained. There was nothing else I could do. I could yell at them but what would that solve? Nothing. They’d probably just yell back.

I don’t know when they finally shut up. But I can say that when they did, the relief in the bus was deep. I settled in for the second night, but slept fitfully.

By dawn, street vendors were heating water for coffee and selling bolos (fried donut holes). I desperately wanted to brush me teeth but no one was selling water at that early hour. I’d have to wait.

And wait I did.

Dozens waited with me.

Semi-trucks and mainline buses littered the roadway. Trash from the evening before was piled randomly about. A herd of goats sauntered up to investigate but they were startled soon after by a child, and ran off.

Not a dog was in sight.
          --Odd.

Everyone seemed to clump together, milling about. Some smoked. Some ate. Some talked on cell phones. All waited.

That morning's wait was the hardest for me. Perhaps it was the lack of sleep the night before, or the massive migraine jabbing the back of my eyes. Either way, I was tired.

What made it worse is I had no way to get any decent food. The buses would take off by 11 am and the restaurants wouldn’t open before then. It’d be hours before I would be able to find anything but a tangerine to eat.
        -- Not good.

By 10:30, the buses revved and everyone piled back on. The passengers were subdued --probably due to lack of sleep-- and the bus driver took us over the bridge. We had to wait another hour on the other side of the bridge for the military convoy to arrive, turn around, and escort us North again.

The trouble was... with all the added precautions, by the time we took off we were made to crawl along at a snail’s pace.

At one point, in the middle of the attack zone, we were forced to park for over an hour and wait. I can only assume it was so the military could patrol a troubled spot. But this is just a guess.

A trip that usually takes about and hour, took three.

Eventually we made it to the end of the convoy. We made a quick stop to load up on water (which I needed desperately by then) and more tangerines. Fortunately, I found a cashew seller who determinedly ran alongside the bus until I could get the right change to pay him. I slipped him the money through the window quickly grabbing a bag of nuts, as the bus drove off.

I ate nuts for lunch.

From there, the trip was more or less typical. We drove quickly in an effort to make up the lost time. And I arrived home by around 6 pm.

Sigh.

When I walked in my front door, I realized that I didn’t have water or electricity due to power failures that day; a shower was out. So instead, I loved on my animals, brushed my fuzzy teeth, and fell into bed.

The next morning, I was finally able to do the mental math. A journey that usually takes about 17 hours had morphed into roughly 46 hours.

It has taken me most of this week to recover.

The up side, of course, was that I got there and back safely. Nothing was stolen and no one was harmed... unless you count that aggressive woman in Maputo who tried to steal my seat. She still might have bruises.

And now... as this particular saga has come to an end. Let me just thank you for praying for me. Please know that I love you all dearly and need those precious prayers desperately.

Please keep praying that my papers in Maputo come through! Pray also for renewed strength, joy, and peace as I tackle the next paperwork obstacles. And pray that I would not lose heart. Thanks.

***Pictures to follow once I figure out how to download them onto my computer.

Tuesday, July 15, 2014

Maputo Bound (Part two... or how my papers moved)

So.... the saga continues.

That first night in Maputo was cold and noisy. The feral dogs antagonized the neighborhood guard dogs.

Barking ensued. Lots of barking.

After breakfast, I caught a city bus (or chapa) for the government offices in charge of my paperwork. It takes 40 minutes or so by bus and is a bit of a circuitous trek off the beaten path.

I made it by 10:30 am only to find the doors locked and the lights off.
    --What? Was it a public holiday?

I looked around and found people watching me jiggle the door handle in dumb confusion.

I turned to them and asked, “Isn’t this the place where I get my Equivlencia?”
-- “No, they moved.” The man looked at me kindly and with much more patience than I deserved. I could see he had had this conversation before.
-- “Moved?” I toyed with the tone in my voice and opted for flat. “Where?”
-- “You have to go back downtown.... then it’s around the corner from the Department of Education.”

I pressed him for clearer directions after insisting I was not a local, but all he could accomplish was to write down the exact same information above. Sigh.

So with a new destination in mind, I retraced my steps to the center of town (another 40 minutes back) and I found the new building. But by this time, it was dangerously close to lunch and I was not sure any staff would even be there.

The building was beautiful. Be-UTE-i-ful. Beautiful!

It shone with the glow of tile wax and chrome. Its steps were covered in well-edged tile and its walls were smudge-free. The furniture looked like it was cut from a magazine --modern faux-finish accented with chrome.

I looked down at my (now) dusty sandals --ineffectively hiding chipped nail polish-- and smiled a little. I was going to dirty up their polished interior. 

As I entered the main office, a clerk was hammering out the finer points of the equivilencia process to a woman in tight jeans and platted hair. She had a beautiful degree stenciled with Arabic calligraphy and bright colors. I spied it over her arm, but the only word that made sense was ‘Qatar’. I smiled at her impishly and waited.

When she left, the clerk asked what I needed and I handed him my file number. I wanted to see how things were progressing, I explained. He handed off my identification number to an underling, who took it and walked woefully to a long row of file cabinets.

I sat down to wait.

Would I have to wait two days for them to find it like last time? I wondered.

Twenty minutes later, I was called up to the desk. The clerk looked confused, my file open in front of him.

-- “We have your file...” he started, “but I don’t know what it means.”
I waited silently. Praying. He obviously had something more to say.
-- “You need to speak to my Chef... but he is at lunch.”
-- “Can’t I see what it says?” I asked, reaching for my file.
-- “No... no. You must talk to my Chef.” He shifted the file slightly away from my hand. A flash of fear in his eyes at the thought I might take it by force.
-- “Did they refuse it?” I asked after a long, pregnant pause. My hands obediently by my sides.
-- “Come back today at 3 pm," he offered. "My Chef will be back from lunch by then.”
Clearly, he did not want me to touch my file or know the secrets it held, so I relented and agreed to return at 3 p.m.

I confess my hopes were not high when I left. My last diploma was rejected... and I was starting to think this one would be as well. Ugg.

I returned to the guesthouse deflated, ate lunch, and napped. But as three-o-clock ticked ever nearer, I found myself back in the shiny, waxed office.

Once the clerk met my eyes, he asked me to take a seat and wait. He had to find his Chef do departemento, he explained. But after looking for awhile and making a few calls, he learned that the Chef was in a meeting. I’d have to come back in the morning.

-- “Can’t you just tell me the results of the file?” I pleaded.
-- “Can you please come back in the morning?” He (almost) pleaded. “Come at 9 am.”
-- “What time does the Chef come in?” I asked.
-- “He gets in at 9 am.”
-- “What time do you open?”
-- “7:30 am.”
-- “I’ll be here at 7:29 in the morning...” I stated flatly.
He nodded that he understood completely, and I left him with a smile. Or was it a leer?

The next morning, I was feeling half nauseated (must have been the chicken I ate on the bus), half nervous (what if he denied my degree?) when I entered the office doors.

I was not there a minute before the clerk called me to the front of the line. (Yes, there as a line at 7:30 a.m.!)

-- “The Chef is not in the office today...” he informed me.
-- “Is there someone else I can talk to?” I queried. “I need to help clear up a misunderstanding.”
-- “Yes. Yes. Let me get her,” he mumbled quietly and scurried off.

While I sat, I prayed. It had been 7 months of this. I’d been filling out paperwork and shuttling back and forth to Maputo for 7 months... and they still had nothing. Why, Lord? What is the hold up?

Eventually, a round-faced woman in a polyester skirt suit called me to the front desk. Her purse was on her shoulder... and I could see she had to leave any minute.

-- “The Ordem de Medicos (or medical board) insist you are not a doctor,” she explained. Lights were going on in my brain.
              --They thought I was a doctor? Oy! Vey!

I nodded to show I understood and waited. She continued to outline that every office they had sent my documents to (two different offices at the medical university and the medical board) all were at a loss as to what to do with me.

I continued to wait.

-- “The Chef has a meeting to go to... we are late,” she confessed. “But I’m going to ask my second in charge to take over this case.” She paused a minute, then added, “There has to be an answer.”

I thanked her and went to wait a bit longer. I couldn’t help but wonder if I had made this journey in vain. Would I have to return to push on this paper in a few more weeks? When would this merry-go-round stop?

Ten minutes later a thin man in a pressed, white shirt and olive green trousers called me forward. My file sat open before him. He seemed genuinely nervous... almost chagrined.

-- “Senhora, we don’t know why the medical board refused your degree...” he explained. “We are going to send it to the Ministry of Health for a review and get back to you as soon as we can.”
-- “Sehnor,” I interrupted kindly. “The medical board is right. I am not a doctor... nor do I pretend to be. The confusion is due to the Portuguese word for midwifery. I am a midwife. My degree is in midwifery. But the word in Portuguese for Obstetrics... is the same for Midwifery. There is no other way to translate this degree.”
As I explained his eyes lightened with understanding and he allowed me to continue without interruption.
-- “I spoke with the doctors in Chimoio,” I explained. “My equivalencia should be for a degree in nurse-midwifery not obstetrics.”

He smiled in relief as I explained and promised to send the file off that morning for approval. He apologized that I had to come so far and especially being that I had to travel through insecurities to get there... and even offered to send my documents directly to Chimoio via courier once they were ready. That was a first.

We exchanged numbers and I left. This has been my 5th trip in 7 months... and I hope it will be my last. My fingers are crossed that the courier will actually work out, but I’m not very optimistic. I suspect I’ll have to return to Maputo again. The question is when.

From there, I was tempted to leave back to Chimoio that night but I was booked for another night in the guest house. I wasn’t sure if I should stay or go. I opted to stay that night and left the next day.

But... the trip back is a story unto itself. I’m still exhausted from the trip... and would rather write when my mind is clearer.

More to come.

Please pray that my documents (no doubt on someone’s desk at the ministry of health in Maputo right now) are approved, stamped, and signed off in record time. Thanks.

Monday, July 14, 2014

Maputo Bound! (Or... How I got stuck on a chicken bus).

My bus ride down to Maputo started out innocent enough. I drove into Chimoio to buy my ticket. (To buy a ticket, you have to walk up to a waiting bus with “Maputo” clearly marked in the front window, find a bleary-eyed driver and pay the fare. It’s not complicated. Each bus leaves promptly at 3 am.)

However, when I got to Chimoio to buy my ticket, the bleary-eyed mister was missing. I asked around as the bus sat empty and closed. Finally, I found one of the drivers who assured me a seat, we exchanged numbers (this is to track me down if necessary), but he didn’t want to take my money just yet. He didn’t have the official ticket booklet. So, I promised to pay when he picked me up that next morning. Everything was set.

Or so I thought.

I got back to Maforga in time for church, lounged around all afternoon trying to motivate myself into packing, then got a phone call.

-- “Sorry, Miss,” squeaked out a thin voice. “The bus isn’t going tonight.”
-- “What? But I was there this morning and you said it was leaving.”
-- “Sorry. You’ll have to come in again and get a ticket for tomorrow night.”
-- “Okay,” I sighed. “See you tomorrow.”

Tomorrow came.

I returned to Chimoio. Repeat. Wash. Spin. And dry.

But this time, there was no call to cancel. So I got team members to agree to get up at the unholy hour of 2:30 am and drive me to my pick up site. There was a bit of a wait. So we watched a restaurant guard sweep up trash in an effort to stay awake and listened to the feral dogs fight.

Gondola (my pick up site) is depressing at 2:50 in the morning. The pale street lamps paint the main street a dusty taupe. Nothing but the sidewalk sweeping man moved. Not even the wind.

My bus arrived. Brakes hissing in protest. I grabbed my bag, thanked my friends, and hustled without a look over my shoulder. If the bus driver doesn’t see you running, he generally starts to honk. It’s annoying.

When I boarded the bus, I was told to take my seat but I couldn’t. A clean-shaven, barrel chested man was sitting in it.

-- “Sit down in your seat,” the ticket master instructed, absentmindedly tying the door shut with a cord.
-- “I can’t. Someone is in it,” I said flatly.
-- “Go sit down,” he repeated. Obviously not listening.
-- “Where? That man is sitting in my seat,” I repeated sourly gesturing toward the intruder. In protest, I sat down in his seat instead.

He looked at me in irritation, the bus lunged forward, and we were off.

Once we were well underway, the ticketmaster shuffled us about and I took my seat next to a nice man from Zimbabwe. He didn’t talk much but he clearly wanted my seat. The view was better and he kept poking his head around to spy oncoming traffic. For reasons still unclear to me, oncoming traffic really interested him. Halfway through the trip, I offered to swap seats with him and he eagerly jumped at the idea. I slept better from then on, and whiled away the hours reading.

We stopped from time to time to pee alongside the road. (Pee breaks are hilarious. The rush to exit reminds me of elephants stampeding. Pushing. Stomping. Cries of protest. Woman tend to veer one way, men the other. I’ve gotten pretty good at the whole semi-squat while wrapped in a kapulana thing. I think I’d be a fierce contender if it were ever an olympic sport.)

The bus was old. It wheezed and coughed up even the smallest hills. When we tried to pass Big Rigs snailing in front of us, the engined protested loudly. Rarely did we succeed.

As a result, we doddered about inching our way to Maputo. 

Every other village, the driver and ticket master stopped to pick up passengers. The stop and go made our travels even slower. Morning faded into late afternoon. Evening blurred into night. More villages. More random passengers.

The passengers started grumbling. Each hour we delayed they grumbled louder.

-- “Why do you keep stopping, Driver?” asked an irritated man from the back.
-- “Yeah,” joined in another, “Is this a Machibombo (a passenger bus for long distances) or a Chapa (a rickety bus, usually topped with chickens and chairs)?”

The driver grumbled to himself and drove on. The passengers grumbled louder but nothing came of it. Their complaints (and mine) were powerless to move the aging mass of steel even one kilometer faster. And the driver could not pass up picking up more fares along the way.

I read some more, stretched cramps out of my neck, and chatted with the passengers around me.

At one point I woke up to find, the Zimbabwean was no longer sitting beside me. In his place were a set of dirty sneakers. I followed them down a narrow passage way between the seats and found my neighbor sound asleep. Miraculously, another man slept beside him! How? I still cannot fathom.

It’s about then that I noticed the chicken. Yep. It crackled in protest each time the brakes squealed. She was close. Somewhere under foot.
    Sigh. I guess I was on the chicken bus after all.

My friends in Maputo (awaiting my arrival) texted in a fit at half past twelve in the morning. Why hadn’t I arrived? What was going on?

I was irritated to have to hop over two sleeping men, a chicken, and 6 bags of junk to reach the ticket master. But I made it.

-- “My friends are worried,” I informed him. “When do you think we’ll arrive?”
-- “We are going... we are going.... “ he mumbled with a faux-smile and diverted eyes.
-- “I know we are going. I can see we are going,” I answered irritably. “My question’s not if we are going but when we expect to arrive. I need to give my friends an answer.”

More maddening teethy grins, shifty eyes, and mumbles.

-- “What? I can’t hear you,” I continued, obviously not impressed. “When? When!? When do we arrive?”

When I realized it wasn’t my accent or lack of Portuguese vocabulary that silenced this fool, I pushed him aside and crawled my way over to the driver.

-- “Your ticket master does not know when we’ll arrive,” I complained. “Can you tell me?’
-- “We’ll arrive soon,” he said a little too quickly.
-- “Soon?” I interjected. “We are already 5 hours late! When will we arrive?”
-- “We are near the city....”
-- “I can see that. I want to know how many kilometers we have to go. I need to inform my taxi driver when to pick me up.”
-- “It’s only 25 kilometers more.”
-- “And how fast are we driving?” I pushed for more answers. “It feels like we are driving 10 kilometers an hour. How fast are we going?”

I tried to look over his dash but it was not lit. I was tired, hungry, and clearly not able to do even simple math in my head... so why I bothered to badger him about this baffles me. But I did.

He never did tell me how fast we were going but insisted it would be only 45 minutes more.

He was wrong.

We didn’t arrive until 2 a.m.

But by then, even the on-call taxi drivers weren’t picking up their phones and the city buses were powered down for the night. How was I going to get to the guest house?

When the bus finally parked for the last time, I shouldered my backpack and hurdled toward the door. The ticket master had it barely untied and I was out like a flash.

Two taxis waited nearby. I’d have to take my chances with unknowns. It wasn’t my first choice, but it was what God supplied. So I prayed and picked the face with the kindest eyes.

-- “I need to go ____,” I told him as I settled into the back seat. “How much do you charge to go there?”

He gave me a price and I haggled.
-- “That’s too much. The price should be lower.”
-- “But you are paying more... because of the hour,” he reasoned.
Smiling at his obvious logic, I nodded that it was fine. And he drove on.

The problem was, I was not completely at ease. I was alone in a cab, in a strange city, with a guy I did not know, and a lot of cash in my pocketbook.
        What could possibly go wrong here?

I prayed as we rode down empty streets and through construction detours. I didn’t recognize the route he was taking, and I asked him about it nervously.

-- “Why are we going this way?”
-- “The other street is blocked off with construction,” he offered with a polite smile. I’m sure he could sense my frayed nerves.
-- “I don’t know this road... are you sure we are in the right neighborhood?
-- “Yes... this is where you need to go.”

He was patient with me. I was frazzled. And by God’s grace, my fears were in vain.

But once at the guest house, no one answered the buzzer. I knew they were expecting me... but no one came to the door. I rang twice, saw curtains move, lights blink on, but still no one opened for me.

I asked the cab driver to wait with me (as the guest house isn’t in a very safe neighborhood for 2:30 in the morning) and he did.

Bless him.

We chatted about world cup results and I stamped my feet in the cold.

Eventually, the guard popped around a bush, key in hand, and opened the gate for me.

The next morning, I learned that the guard was fast asleep and was the only one with the gate key. The guesthouse staff had to first find him, then wake him out of a dead sleep before he could let me in.

Figures.

The  journey continues... but my eyes are drooping. To sleep, I go.

More to come.

Wednesday, May 28, 2014

First Step.


A journey of a thousand miles always starts with that first step.

And my journey --of opening this clinic in Moz-- has begun.

Finally.

The first step is complete.

I have the signature! (And I did not have to pay a bribe to get it!!!!)

I can open!

As I look back over all the waiting, praying, pushing, and crying I’ve done in the process of taking this first step, I’m both horrified and relieved.

I knew starting a work in Moz would not come easily. But with God’s promises that it would (eventually) come, I held on.

I’d be lying if I said that through these long, strange months my faith was always strong.

More often than not, I was shaken.

I have been discouraged... and often frustrated.

        Lord, I believe. Help my unbelief!

But now as I lift my other foot and stretch it in faith for the next step, my heart soars in gratitude.

        Praise Him! He is faithful!

He guides my steps. He goes before me and behind. He surrounds me in His love!

So what now?

Great question.

Now I have to take 4 more steps.

  1. I need a document called an AVORA, which will allow me to purchase medicines for the clinic. (I started this process today!)
  2. Then I need to restart my ‘equivilencia’ process which will allow me to legally practice as a midwife. (I’ll have to go back to Maputo for this... pray for the right timing.)
  3. I’ll also need to start actively interviewing nurses and putting ads on the radio station for interviews. (I’m not sure when to do this. Pray for wisdom!)
  4. Lastly, I’ll need to finish all the unfinished construction projects at the clinic to make it inspection worthy. (Because this takes SO LONG, I’m starting this process today. I will be interviewing a new construction crew to help me complete it faster. Pray for discernment and enough funds for the projects.)

Thank you awesome prayer warriors! Thank you faithful friends! Thank you!

Keep praying.

Sunday, March 9, 2014

My Papers.

This week has been ... well... interesting.

To say the least.

I went to Maputo in search of answers. My papers. I needed my papers. The broken record in my head stutters over these two simple words.

My papers.

You, who have followed my adventures these last few months, know well that I’m in need of My Papers to open the clinic. But I have not explained what it means and why it’s so important.

Forgive me for that.

Now is the time to explain.

I’ll try to be brief.

Last October, it dawned me that I’d have to get my midwifery degree approved in Mozambique in order to practice. So I stumbled through the paperwork process, trying to decipher the litany of stamps, translations, and certifications needed to submit it.

My Portuguese was not as good then ( 6 months ago), and I was uncertain as to how to proceed. But I eventually mustered through them.

However as I tried to submit them locally, the Minister of Education encouraged me to instead go directly to the source --Maputo.

“Everything is done in Maputo”, he said looking highly distracted. “You’ll save months of waiting if you do it there.”

Why? Was he just too lazy to help? Or was he right?

I wasn’t sure. But I decided to believe him and so sent my documents with a friend to Maputo.

But once in Maputo, my friend was scolded for having done them wrong and was informed they’d have to be redone to include an even longer list of criteria.

So I went back to the drawing board, reworked them, and then submitted them again. But this time I went in person.

Unfortunately, I’d lost a good month in the process.

But even after re-working them like mad, I’d apparently done it wrong again. I had to stay several days running around Maputo finding even more stamps, photocopies, and signatures.

Not easy.

(Since I was at it, I decided to get both my diplomas recognized and submitted my Theology degree alongside my Midwifery degree.)

After a number of days, they finally accepted my documents, instructing me to return in a week to follow up.

-- “Really?”, I asked in excitement. “They’ll be done in a week?”

The woman behind the counter looked at me like I’d been hit with the stupid stick more than once and hissed lowly, “No. But come back anyway. We might have problems with your application and need you to fix it.”

-- “But I live 17 hours drive away,” I pleaded. “I cannot come back next week.”

Not even trying to hide her annoyance, she suggested: “Just stay in a hotel then, and come back next week.”

-- “Hotels are too expensive...” I argued on stupidly, “I’m a missionary. I cannot afford to live in Maputo for a week only to be told if my application is correct or not. Can’t you give me a number to call so I can follow up from my province?”

Sighing in a deeper annoyance than before she spat, “No!”, adding tersely, “You’ll just have to come back in a month!” Then she quickly turned her gaze to the woman standing behind me, stack of papers in hand, and asked, “Neeexxxt?”

I left a bit dismayed by her attitude, grumbling the words “Functionary!” under my breath. But I couldn’t help but feel relieved. After two months of sweating over these documents, they were finally submitted!

A month went by... and I returned to check on the papers.

The 17 hour bus ride there was not easy. Cramped. Hot. Stinky. But I made it back to this nation’s capital intact and ready for anything.

Well... almost anything.

I didn’t know I was so doggedly optimistic about getting approved, until I walked into the same small office and found the same disgruntled functionary behind the desk.

When she told me that neither of my degrees had been decided on yet and that I should come back in another month, I balked.

This was during a time of rebel activity and it had been unsafe for me to travel by bus in the first place. Rebels were bombing vehicles along one stretch of the road... and I could not keep coming back only to be told to wait... and wait some more.

-- “Can’t you, please, just give me a number to call?” I begged. Then I explained the distance and insecurities of travel for a single woman.

She seemed more inclined to help me this time. And after some deliberation, finally agreed to give me the number for their office.

I thanked her, then left that night. The 17 hours it took for me to return was starting to get a bit easier. I made friends along the way. I took in the sights. I was even able to sleep sitting up.

But once back home each time I called to follow up, no one answered the phone. This went on for weeks... a month.

Finally, frustrated and annoyed now, I returned once again to Maputo.

When I walked into the cramped office for a third time in so many months, I was deeply annoyed that the woman seemed smug. She asked a bit haughtily, “Aren’t you the one from Chimoio?”

-- “Yes. That’s me,” I said trying to keep the distain from my voice.
-- “Why are you here?” she asked pleasantly. “I thought you were going to call? Didn’t you say last time it was unsafe for you to travel?”
-- “Yes. It is unsafe to travel... but I didn’t have any choice,” I explained. “Each time I called, the phone just rang and rang. Then after some time, it said that it was not connected.”
-- “That can’t be,” she protested. “You must have been dialing the wrong number.”

I repeated the number to her and she nodded that it was correct, looking confused.

Another woman, sitting further back behind stacks of folders popped her head around to throw in her two cents. “It must be your phone,” she argued. “Try calling it now.”

I did as I was asked and my phone flashed once again that it was an invalid number. I showed it to her, not hiding my smug expression. Did she really think I didn’t know how to make a call?

Then I watched her pick up the phone, switch it on underneath, then insist I call it again. I did what she asked and found the number rang.

Sigh.

The phone of a whole department had been turned off --literally turned off!-- for a month.

Oh! Mozambique!

Okay... okay.... I know I’m taking a bit longer than I expected. I guess I have more to say than I realized.

Please bare with me. I have more... but not much.

Long story short, I was informed once again that my papers had not been done and that I’d have to return. But this time, they gave me two numbers to dial instead of one.

Dejected and more than a little frustrated, I journeyed home to once again report nothing had been done.

But by this time my relationship with local Ministry of Health official was better, and he decided to help me push this through.

So when it came time to call again for a answers, he called for me.

But would you believe it... both numbers they gave me were false! Neither worked even though his secretary called every few hours for two days.

He did not seem surprised.

-- “You’ll just have to go back again,” he told me with a sad shake of his head.
-- “Really?” I sighed. “There is no way for you to get different numbers?” I knew I was reaching, but I had to ask.
-- “Nope,” he sighed back with genuine sympathy, “Sorry...”
-- “Okay... but what can I do differently?” I asked desperately, “Can you offer any advice?”

He hesitated, rocked back on his chair, then smiled. “Yes, I can offer you some advice.”

Then he quickly explained the ‘White skin factor’ of such delays and encouraged me to get the secretaries’ boss involved. The plan was simple. Go over their heads... but do it politely.

Bus trip number four.

Still cramped. Still stinky. Still hot. But somehow easier... almost routine.

This final time was earlier this week. I managed my trip so I could walk in to the cramped office bright and early on Monday morning.

The functionaries were rushing about and obviously busier than usual. Once it was my turn, I was told to wait a bit while they searched for my file.

I waited... and waited.

And waited.

I wasn’t annoyed though as I could see they were systematically flipping through a long wall of file cabinets, and asking others to help search.

An hour went by and she finally called me up to the desk.
-- “Your file is lost,” she almost whispered.
-- “Lost?” I asked incredulously, cocking my eyebrow up for emphasis.
-- “Please give us today to keep searching,” she pleaded in hushed tones. “If you give me your number, I’ll call you once it’s found.”

I gave her my number out of curtesy never once believing she’d call. Then I added, “But either way, I’ll be here tomorrow morning for my file.” The warning in my voice was clear.
She nodded gravely and I left.

The next morning, I arrived to find that they had not even searched again. Asked to take a seat and wait, I watched two men slowly make their way through folders stacked in clumsy piles amid battered boxes.

Another hour went by.

And I prayed and prayed....

Sometimes I prayed that my files would be found.... but mostly I prayed that I would not reach over the desk and gouge out the functionary’s dark eyes.

Yes. I know. Not very kind of me. But true.

I didn’t want to shame Jesus by even using a harsh tone in my voice.... so I guess it’s a good thing I had an hour to pray!

Eventually, I heard her call for ‘Stephan’ (most Mozambicans forget to add the last syllable) and I jerked my head up in response. Our eyes met and she called me over.

-- “This is one response,” she said dryly, handing me a stamped paper. “You’ll have to sign here,” she added, pointing to the top of the page, “to say that you’ve received it.”

My heart jumped. Was this it? Had I finally done it?!

My eyes scanned the paper.... something didn’t seem right. So I read it quickly, my heart sinking as the bold script screamed denied.

Denied?

I read it again. And again...

It was my Theology degree results. They refused to recognize it, claiming my school was not accredited.

“Hogwash!” I thought to myself but I didn’t say that. Instead, I nodded that I understood and signed where she had indicated.

I had been sure my Theology degree would be approved. Sure! The fact it hadn’t honestly frightened me. Could this be? Would they really deny my education? Not possible!

Once I calmed down a bit, I stared at her with determination until she met my eyes again. She looked uncomfortable. Really uncomfortable.

I think she expected some kind of argument.

But I didn’t argue. I didn’t really care about my Theology degree. What mattered was my midwifery degree. What were the results there?

-- “What about my other degree?” I asked flatly.
-- “They are not done yet.”
-- “Not done?” I asked incredulously. “But it has been over four months!”

She looked dejected but somehow also sorry for me, then said, “I don’t know, Senhora.”

A long pregnant pause.

She made no effort to explain or apologize further so I leaned in closer.

-- “Very well,” I said calmly, “In that case, I’ll need to speak with your boss.” This is what my minister friend had instructed me to do.

She didn’t even bat an eyelash. Instead she nodded gravely, called an office assistant over, and instructed him to take me to the boss immediately.

Ten minutes later I was sitting at the boss’ desk, appealing for help. At first he seemed irritated with my requests for aid, but with time his frosty demeanor warmed.

-- “Please, Senhor,” I pleaded. “I really need your help... four months for an answer seems too long. Something is wrong.”

He hesitated, seemingly puzzled as to what to do, so I waited for him to think it through. But even then, he flipped it back on to me.

-- “What should I do?” he asked innocently. I honestly wanted to laugh in response. Was he really asking me how to do his job?

Seriously?

Sigh.

I told him what I thought was to be done. He listened kindly. I continued on, detailing possibilities and options. He thought about them, distractedly shuffling papers about his desk.

Then I sat silently and waited.

A few minutes later, a decision was made and he enthusiastically went about getting it done.

First it started with curt orders to the secretaries. “Write this and that! Sign it there!”

Then it was fruitless phone calls to the other departments. “Why don’t they answer? Call again!”

Then it was long explanations of detailed plans to make it happen, all his secretaries listening intently and nodding deferentially.

Finally, he turned to me and promised answers the following day.

I thanked him and left.

But the following day, the secretaries barely looked at me entering before they called for another office assistant to take me to the Boss.

This was not looking good. The dread in my stomach ate acidly up my throat.

Gulp.

Was this going to be another denial? Would I have nothing to show for this 6 months of labor but a bad story? Really?

Once in his office, I tried to smile but failed. I could only coax my lips to press in a tight straight line -- the dread barely caged behind my teeth.

Before he spoke, he shook his head in disgust almost as if in warning. A full minute passed while he busied himself with a stack of papers needing signatures.

I waited silently, not trusting my teeth to hold back the dread.

But when he spoke, I was relieved to learn that I was not denied --not yet at least. No.... in fact, it was more a matter of incompetence. And he was not happy to admit one of his departments had dropped the ball.

-- “Senhora Stephanie,” he started, “The paper was sent to the medical university for approval.” I nodded. He continued, “They didn’t know what to do with it and refused to decide.” I nodded on but a look of confusion clouded my eyes and furrowed my brow.

-- “What do you mean?” I asked.

-- “They referred your degree to the specialist department of the medical university for review. But they never actually took it there. So... it’s been sitting on someone’s desk for over a month and a half. Just sitting there!”

I was flattered by the indignant tone in his voice. He seemed as upset about it as I was. They had obviously dropped the ball.

-- “I’ve managed to get it sent to the right department yesterday, but you’re going to need to push it from Chimoio.”

I listened, nodding periodically. He spoke so quickly and used such high Portuguese that I was at a loss several times. Fortunately, his irritation caused him to repeat himself often. Eventually, I got it.

He instructed me on the best way to proceed, but it requires lots of favor. Lots. This is where you all come in. I need your prayers.

I am now back in Chimoio, and tomorrow I head in to speak with my friend at the Ministry of Health. I have to ask him to get involved again, but this time I need him to do more than make phone calls.

I’m not sure what he’ll say. Frankly, I’m worried. We have a good relationship, but I now have to ask him to send a delegate from the Min. of Health in Maputo to lean on the Min. of Education medical department in Maputo.

This apparently is the only way it’ll happen. Sigh.

But more than that... the hang up seems to be more about me being “Just” a midwife. I need his delegate to explain what an expert midwife is. They don’t have a category for one here it would seem. And I need to ask them to make a new category.

I might as well be asking for the moon.

If not, the likelihood of me being denied is high. Too high for my comfort.

My heart doesn’t know what to think. My brain just turns circles. My body would like to scream... or maybe run away screaming.

Yeah. That.

I want to run away screaming while my head turns and my heart bursts silently.

Okay... that might be a bit much. Actually, I’m mostly at peace... with periodic bouts of panic.

If you would... if you would only please, pray for:
-- My relationship with the Min. of Health to be strong enough for me to ask for the moon.
-- My diploma to be approved as is... or a new category to be made for me if need be.
-- For this labyrinth of paperwork to finally come to a close. I’m dizzy from all the blind alleys and dead ends.

Thanks.

I love you awesome prayer warriors!