Life in Malawi

When John and I were back in America last March, I was asked many times "don't you just love living in Africa?"  My response was usually, "Well...not every day". 

I know many of us are trying to "live our best life now" and "creating the life we want", but can we be real for a minute?  How many of us love every moment of our lives?  I don't think I'm the only one who gets frustrated, annoyed, and irritated multiple times in a day .  There are "first world problems" and then there are most definitely "living in a very poor African country problems". It would be so incredibly easy to make a new list of 10 Malawi problems each week (and sometime each day). These problems are real and sometimes horrifyingly awful.  But today I'm challenging myself to share 10 things I love/appreciate about Malawi (in no particular order).  Because even though I don't love living in Africa every day, there are many things I do love here and am grateful to get to experience.  And most of these make me smile and laugh.  OK.  Here we go...

1. Singing OK, I know people sing all over the world. But here in Malawi, there is a freedom and release in song that is so refreshing. Some of my research involves women who are undergoing surgical repair of an obstetric fistula. The patients gather almost every morning and belt out worship songs together, usually in call and response. Those that can harmonize, will harmonize and the sound is stunning. This is the best background music I could ask for as I try to compile and analyze data. I can't quite imagine any post-operative ward in the United States gathering in the common area for morning singing. 
Songs are also used to teach health information. At most health facilities in Malawi, no one has an appointment. Patients are all walk-ins, first come first serve. When I arrive at our district hospital at 7:15 am, there are already lines 50-100 people long in each of the many clinics. Before the health providers start the clinics, the gathering of patients receives health education. A common component of these educational talks is a song that summarizes the important points. Many patients already know the song and and those that don't yet know it seem to learn it quickly to join in. Hearing these songs in the mornings gives me hope that knowledge barriers to health can be broken down.

2. Learning and working to understand local culture This one is not always easy and sometimes my discoveries do not always make me feel good. But when situations and interactions that have been buzzing by me suddenly make sense after a kind Malawian explains what is really going on under surface the Aha moment is great. There are way too many examples of this to count. 
About 10 months into living in Malawi, I drove by a large crowd of people running to look over a bridge. After arriving at work, I asked a few women with whom I share an office to give me the scoop of what was so exciting that everyone was peering over a bridge. I was told that a man had stolen money from a local business and as he was being chased jumped over the bridge.  No one could find him anywhere. I asked, "Do you think he drowned or did he get away?" The women looked at me like I had three heads and one said, "He probably turned into a snake." Not the response I was expected, I shared the story of the thief who jumped over the bridge and couldn't be found with several other Malawians over the next week.  Each time when I asked what might have happened to him I was given the same response: "He probably turned into a snake". I learned that the beliefs about magic, curses, and witchcraft that I thought were relegated to a few uneducated people in remote places are actually pervasive in many parts of society (many people that gave me this response are quite educated, reasonable, and responsible people). It later helped me understand many other situations happening around me where it appears difficult to confront anyone when they are not doing the right thing : curses from other people that you have embarrassed or angered seem very real.   

Another cultural lesson: the current president discourages attacks against people with albinism. Noted.

3. Trying new recipes from scratch We are very blessed to have three meals a day and realize that not all of our neighbors have this luxury. However, figuring out how to make three meals a day from what is available is not always easy. My favorite go-tos from Trader Joe's are clearly not options and even food I saw in the grocery store last week may be out of stock for the next 3 months.  This has led to a lot more creativity in our cooking. John loves pizza and has been trialing a variety of pizza dough recipes throughout the year. I've made some new curries, we've roasted whole chickens (those boneless, skinless chicken breasts are more rare and expensive), and learned how to make the stranger banana varieties edible (muffins). 

4. Malawian English I promise we do use some Chichewa (our local language) phrases, but still mostly converse in English. However, we continue to realize that not all English is  equal (at least in phrasing or meanings).  On safari with John's family in September he was asked, "How do you sex a warthog?" Alarmed at first and with beastiality concerns, we then realized that the question in American English would have been "How can you tell the difference between a male and female warthog?" 

 5. Switched Pronunciation of the letters L and R To be fair, this is not unique to Malawi (I have encountered this difficulty in many areas of the world). However, the frequency to which the letters l and r are switched in pronunciation of English words sometimes leads to confusing or amusing situations. Last year I was told that there was a package ready for pickup "by your friend Ree-Ree". I must have had a strange look on my face trying to recall anyone I knew here with a name similar to this. The secretary kept at it, "You know Ree-Ree, your friend: Ree-Ree." There is a strong assumption that I must know and be friends with all Caucasian people  here so I started running through a list of ex-pats in my head.  Finally, it clicked!  "LILY!" I exclaimed. The secretary answered "Yes...that's what I said.  Ree-ree." The hardest to keep a straight face is when the word for the process of voting is pronounced with an r instead of an l.  

6. Learning about other cultures Americans are not the only westerners working and living here. We have met lovely British, Irish, Norwegian, Scottish, Zambian, South African, and Australian people and gotten to learn about their homelands in a variety of ways.  Today John started to learn to play gaelic football. This Irish sport lets you kick, throw, and bounce the ball as well as contact your opponent.  It's fun to share and discover differences in approaches to government, healthcare, and sports. 


 

Some of my pregnant patients jumping rope just outside the hospital (and trying to go into labor)

7. When good things happen to my patients OK, I definitely wish more patients of mine would have good outcomes, but with the transport, medication, staff, and supply issues it isn't always possible. However, last week my first patient in my infertility clinic was pregnant. After many years of trying to conceive, along with the severe judgment stigma she received...success!  The Malawian nurse translating for me started clapping and dancing in my consultation room with the patient while I clapped and smiled for her (still a subdued American). I diagnosed another of my patients with a hormonal imbalance and was able to correct it with medication.  Two months later, she was pregnant. Perhaps the infrequency of getting to participate in good outcomes makes them all the more sweeter.

8. Different life rhythms John and I sleep for 8 hours almost every night of the week.  (Not during my labor and delivery call days, but still).  We both have more flexible schedules than in prior jobs and can work from home sometimes (clarification: when I'm working on research-I don't see patients at our home).  We have many unscheduled evenings and weekends where we can cook, watch movies, rest, read good books, play games, and have people over for dinner. We both realize that life won't always look this way but are appreciating and enjoying this season of rest. 

9. Beautiful African fabric Most African women wear chitenje or brightly colored printed fabric around their waist when they are traveling. (Usually on top of their dresses or skirts and thus it is also called a "wrapper").  Chitenje is also used as a baby carrier (and a bit cheaper than a baby bjorn or ergobaby). I love seeing the rainbow of colors and unique array of patterns everywhere. 

10. Enthusiasm in the medical interns and residents I love the opportunity to get to teach Malawi's first classes of Ob/Gyn residents as they complete their training here in Lilongwe. So many of them are curious and eager to learn as well as provide excellent care of our patients. I hope and believe they will become the medical leaders and advisers for this country, so I try to teach them skills that are useful in the hospital as well as skills in reading and understanding medical information and research. In Malawi, when the medical students graduate, they spend 18 months doing an internship in the government facilities. Six months of their internship is dedicated to learning skills in Obstetrics and Gynecology. After their internship, they will likely be the most senior clinician at their assigned medical facility, so I try to teach them important clinical skills (especially what to do in emergencies!). Though I know many things I do here may not have impact after I leave, I hope that the interns and residents I teach and mentor will remember a few lessons that may impact the lives of the patients in this country.

So these are the 10 things about living in Malawi that I am choosing to remember and be thankful for today. A spirit of gratitude shifts our focus from what is lacking or dysfunctional to the abundance that is already present. It isn't easy and definitely doesn't come naturally to me, but is an attitude I am working to cultivate. May you also be able to look around your life and choose to appreciate the blessings you have been given right where you are now. 

"This is what will determine a fulfilling, meaningful life, a life that, behind all the facades every one of us longs to live: gratitude for the blessings that expresses itself by becoming the blessing." Ann Voskamp

"Give thanks in all circumstances; for this is the will of God in Christ Jesus for you." 1 Thessalonians 5:18
 

Friends, family and fun...

Victoria Falls - Zambia

These last couple months have been filling with a wide range of emotions and experiences here in Africa.  Since we last wrote in May, we have seen a great many friends end their time here in Malawi and transition back to their lives in the United States.  It is often said that you don't know what you had until it is gone.  Well, that wasn't the case with us.  We knew exactly what we had.  We had an amazing community and group of friends here, and we are so thankful that the Lord blessed us with a wonderful year spent with them.  And yes, now that many of them have gone back home, they are missed, they are thought about, they are prayed for, and they are appreciated.  And I hope that they all know how much they are and will be missed this year!

Summit Church and Malawi Staff

In May, I (John) had my first mission group come back for a second trip.  Last year, the group from Summit Church in Orlando Florida spent a week traveling around the villages of Salima, spending a lot of time with a support group of people living with HIV/AIDS, and getting to know many of the staff in the district.  This year was a reunion with two of the group members (Lauren Gaines and Alison Porter) who were joined by four new members, and really dove into building relationships with the Malawi staff.  The Summit team facilitated a "Strength Finders" workshop for 13 members of staff who work together on a daily basis.  It was a wonderful time getting to know each other, getting to know ourselves, and seeing all of the strengths that were already at work within the group.  In addition to the workshop, the team was able to get out into the community, attend a church service in a local village, tour a new windmill project that is bringing water for irrigation into the community, and bring a lot of joy to local villagers every where they went.  It was a wonderful week, and a true highlight of my year.

Victoria Falls - Zambia side

Victoria Falls - as seen from a bridge connecting
Zambia and Zimbabwe

Dawn and I were also just recently blessed with a visit from Dawn's parents (Mike and Chris Flandermeyer).  For Mike, it was his first time flying out of the United States, and for Chris, it had been many years since her last world tour.  They both endured the two days of travel to get here, battled with jet lag, spent a great day at Lake Malawi, and then we made them jump on another plane!  We spent an amazing week visiting Victoria Falls and South Luangwa National Park in Zambia.  Victoria Falls had been on Dawn and my bucket list ever since we knew we were coming to Malawi.  It is one of the seven natural wonders of the world.  If you ever get a chance to visit, it is well worth it.  We spent three nights near the falls, had a couple sunset cruises (because one just wasn't enough), had a walking tour through a local village that lodge we stayed in helps to support (education and development), and spent a good part of a day walking all the trails around the falls getting pictures from every angle available.

Zambezi River on sunset cruise

Part of "journey" of 14 giraffes

After our third night, and a leisurely morning, we boarded a plane and flew back across the country to  go on safari.  It was an unbelievable experience.  We arrived at our lodge after the sun had set, yet we were greeted to a lighted viewing deck that overlooked a landscape teeming with antelope, birds, hippos, and  crocodile.  I couldn't have imagined a more amazing view to start our safari.  The next morning we had a 5:30am wake-up call, 6:00am breakfast, and by 6:30am we were loaded in our safari vehicles covered in blankets ready to see animals (it is winter here in the Southern Hemisphere).  And see animals we did!!! Antelopes (many kinds), warthogs, elephants, water buffalos, lions (6 of them), leopards (up close and personal), giraffes (first a "journey" of 14, then another of 17), and more beautiful birds than we could even count or identify.  South Luangwa unfortunately does not have any rhinos, but we did see all four of the big five that they do have (elephants, water buffalo, lions and leopards).  It was an unbelievable drive to start the trip with, but it really set the stage for an incredible stay.

Things did get a little emotional on our last morning as Dawn and I were heading back to Lilongwe, while Mike and Chris were continuing on to spend a week in Cape Town.  It was so great to see family, which we have been looking forward to for so long.  But it was also hard to have to say good-bye and not know when we will be seeing them again.  Mike and Chris, thank you so much for flying half way around the world to see us! We were so very blessed, and we made some incredible memories.

Lucky for us, we won't have to be without family for long.  My parents and sister (Jim and Lesley Kopp, and Michelle Schmutzler) are going to arrive in Lilongwe at the end of August for a visit.  Similar to the Flandermeyers, this will be the first time any of my family has been to Africa, and we are looking forward to making more incredible memories!

Thank you all for your continued thoughts and prayers.  Please pray for us as we begin our second year in Malawi, and may it be as rich and rewarding as the first.  As you all know, it hasn't always been easy here.  We are praying for new friends and deeper community.  We also pray that the Lord give us the eyes to see, the ears to hear, and the heart to understand the ways in which the Lord is moving here in Malawi: both through us and around us.  The Lord is definitely active here in Malawi, and we are blessed to be a part of it.

God bless you all!

John (and Dawn) Kopp

Less...and More

These past 9 months have been about a lot of paring down.
Stripping away.
Slimming down.
Trimming away.

Less close contact with the friends and family that we love.  Less of our possessions.  Less of the familiar and comfort of a home culture.

Our trip back the U.S. was both good and hard.  It was good to be back in the abundance of the United States; but hard to leave.  It was so good to be back in the presence of our cherished relationships.  It was good to feel we had common understandings with those around us.  It was good to have the luxury of a coffee shop or stocked grocery store nearby.

But somehow that made it more difficult to leave to go back to a place where we have less.

Here in Malawi, there is less steadiness to our lives.  As John mentioned in a previous post, almost all of our close local friends are leaving in the few weeks.  These are people with whom we have prayed, shared meals, climbed mountains, worshiped, vented, and laughed with this year.  Continuing in life here without them feels hard.

At the same time, the work demands before me seem to be increasing: getting study protocols through ethics boards, navigating the correct channels to secure funding and personnel to carry out new research studies, learning to perform new statistical analyses to write as many manuscripts as fast as possible,  seeing enough patients and studying enough to qualify for an upcoming board examination, making enough connections and doing enough soul-searching to discern the next career step, and making the most of the daily limitations at the hospital to meet the needs of my patients. 

And in a place where we don't know if there will be milk at the grocery store, friends after June, internet connectivity to connect with colleagues, or electricity when we make dinner it feels like God is asking us to live a life of less.  I'm not sure that I can confidently say I am doing this well.  I pray that as the excess is trimmed away, I can clearly see God's purpose.  By opening my clenched fists to let go of my expectations of how we thought life was supposed to go, will I receive something I didn't imagine?  Will God show me that many of the assurances I try to count on each day are actually illusions?  Will I accept that there is no assurance other than His faithfulness, His strength, His hope?

Lately, I have been studying the life of Gideon, featured in the book of Judges.  There are many comforting aspects of this story to a struggling believer.  God incredibly asks this man who is considered the least man in the least tribe to go and defeat the enemies he is hiding from.  God still insists on Gideon going to defeat the Mideonites after Gideon accuses God of abandonment and asks for signs.  But then, God gets really extreme: He asks Gideon to let his soldiers go home until he is fighting at a ratio of 450:1.  God tells Gideon that "You have too many warriers" and that He is clear that He doesn't want the Isrealites to be able to boast in their own strength if they win the battle.  Priscilla Shirer calls this the "God Margin": the space/disparity between where our skills and resources end and what God asks us to do.  Over and over in the Bible and in the stories of believers today, God seems to like turning weaknesses into strength, making impossible things possible, using foolishness to confuse the wise, and doing more with less.

Perhaps our sparse life in Malawi seems to be making room for God to work.  In releasing comfort, clarity, and stability of relationships, maybe I am giving God more.  More room to display His strength in my weaknesses.  More room to turn impossible situations into success stories.  More room to bring wisdom into the cloudy confusion of the future. 

Maybe I don't need everything I thought I would need.  Maybe less really is more. 
Each time He said, “My grace is all you need. My power works best in weakness.” So now I am glad to boast about my weaknesses, so that the power of Christ can work through me.
2 Corinthians 12:9 

Around the world...and back again!

Gateway Arch in St. Louis - Made it to the top

We are now 7 1/2 months into our African adventure, and we did not expect to be able to see friends and family for over a year, but as it turns out we have just returned from a trip back to the States.  Dawn's sister got married March 7th in St. Charles Missouri which brought us home for a visit.  It  was a welcomed rest from our lives in Malawi.

Kopp Family at Pike St. Market

The Russell Clan

As it turns out it was cheaper for us to have round trip tickets from Malawi to Seattle, and then buy round trip tickets from Seattle to St. Louis.  So even though it meant more airports, more time-zone changes, and more jet lag, we opted for the cost conscious travel option.  All-in-all we were able to see my family, Dawn's family (and extended family with the wedding), packed every night with dinners with friends, many lunches with other friends, and even the occasional breakfast with even more friends.  We filled our days with many activities: a day of skiing (though John had to hike up Mt. Rainer to do it), a hike in the rain, a family day at Pike Place Market, a game of ultimate frisbee, a road trip to Portland, worship at our home church in Seattle, listening to friend's preaching at the college ministry he now directs, participating  in a beautiful wedding, getting in a few good workouts, playing with babies that we had met for the first time, and seeing many kids that have grown up so much since we had last seen them.

John and JB on Mt. Rainer

Needless to say, we packed as much into our time as possible.  For those of you we were able to see, thank you so much for making time for us.  For those of you who we were not able to see, please know that you are still loved and remembered.  It often takes a trip like this to realize just how many friends and family we do have, and how blessed we are by that.

Heidi's Wedding

Grandma Lois and Baby Thea

We were able to spend a week in the St. Louis area with Dawn's family for Heidi's wedding.  It was such a joy to be a part of this wedding, and see my sister-in-law marry such a great guy.  Dawn and I were both asked to be a part of the wedding party.  I was a lowly groomsman, but Dawn was the maid-of-honor (and she looked hot!!!).  The wedding was held at this beautiful spot called the Conservatory that is right in the heart of the historic part of St. Charles.  The reception was right down the road at this great little Irish Pub where they were able to reserve the entire basement.  As Dawn and I talked about it after, we both thought that they were perfect places for Heidi and Nick.  Both places were fun, cozy, and had great character.  So fun to be a part of it.

Noah Watson

Riley and Isaac Gish

We loved being home and seeing so many people that we care deeply about and miss.  At the same time, we are reminded of how blessed we have been here in Malawi.  We have developed an incredible community, been blessed by a wonderful Bible study, and have had so many fun adventures together.  We also realize that we are headed into a huge transition in the next couple of months.  Almost all of our good friends here will be leaving in May or June.  Their one year commitment is quickly coming to an end, and it has made us very mindful of the fact that we still have another year here after they leave.  We know that the Lord has been so faithful to us in providing us with incredible community, and our hope and prayer is that He will do it again.  Please join us in that prayer.

Even though we are sad to know that so many friends will be leaving Malawi, we are encouraged by a good number of people who are going to come and visit.  Dawn's good friend, Amy Mott, will be coming for a visit in May.  Dawn's mom and dad will be coming in July.  My mom, dad, sister and possibly my "little spunky aunt" will be coming at the end of August.  And finally (unless more of you decide that you want a great excuse to visit Africa) my good friend Aaron is going to coming for a visit in October.  That is a lot to be thankful for, and we are!

Thank you all for your continued thoughts, prayers, financial support, and love.  As you know this adventure has had its share of challenges (we both had items stolen from our bags in Africa and finding the right car parts when our car broke down took weeks), but it has also had many more blessings.  We continue to be thankful the opportunity the Lord has given us to be here, and that we get the chance to do this together.  We have had so much more time together as a couple than we ever had in America.  And we still like each other!  Experiencing the struggles and joys of overseas life together and being able to turn to each other for support has been an incredible gift.  These memories will last a lifetime (or until at least until dementia hits).  We are thankful for your support and the way you are sharing in this experience with us.   God Bless.

John (and Dawn)

P.S.  We (especially Dawn) love mail.  Letters, cards, or small care packages give us so much joy.  (warning: expensive items may be stolen by postal officials) 
If you are in the mood, our address is:
Dawn Kopp
UNC Project
Private Bag A-104
Lilongwe, Malawi

The Holidays in Africa

Cape Town - Table Mountain in Distance

Sorry that is has been so long since we have posted.  It's crazy how time can fly by no matter where you are.  So the post that I really want to write is about the opportunity I got to go back into the field to witness a number of village savings groups.  It was incredible to see how people with so little can take so much joy from doing something on their own.  But before I write that post, Dawn suggested that I write about our Christmas experience and vacation to Cape Town.  So keep checking back to hear about the savings groups, probably later this week.

Our Christmas Tree

Dawn and I were blessed to be able to spend our first Christmas in Malawi with our house-mates the Gallahers, their 2 1/2 year-old son Lincoln, and Laura Gallaher's parents from the US.  I was able to buy a large fake Christmas tree, so we were able to enjoy that tradition.  The tree decorations were 100% Malawi though.  Most of the decorations consisted of Lincoln's toys tied with string and hung on the tree.  At one point we had two plastic horses, one with only three legs, a little red wagon with three wheels, a "The Simpsons" character, a wooden hippo, a bunch of handmade ornaments, popcorn garland, and Lincoln's blanket.  It was quite the eclectic tree, but it just felt right!  Waking up Christmas morning to the joy of a 2 1/2 year-old was also quite special.  It is always fantastic to see the day through the eyes of a child.  We will remember this Christmas for years to come.

Ryan Ingram - Mt. Mulanje

Reality hit a couple days later as Dawn had to work at the hospital again with a 72-hour call shift.  So being the loving husband that I am, I decided the best thing I could do was take a friend and go on a backpacking trip for 5 days.  It sounded like a good idea at the time.  But it turned out that there were a couple days that Dawn was all by herself in our compound after the Gallahers had taken off on a vacation to Cape Town, and she did not feel comfortable.  So Dawn had a little slumber party with Kelly, Mattea, and Camrie Ingram (wife and two daughters of Ryan, the friend who I had taken with me on the backpacking trip).  We truly have been blessed with some great friends here in Malawi, and I was so thankful that Dawn was able to hang out with the Ingrams instead of being scared and alone while her big tough husband was playing mountain man.

Mr. Penguin

Dawn greeting the natives

On the 2nd of January Dawn and I boarded a plane and flew to Cape Town South Africa.  For those of you who have been there, you know how beautiful it is.  For those of you who have not, you definitely need to put it on your bucket list.  It is one of the most beautiful places I have ever been.  The city itself is breathtaking with Table Mountain, Lion's Head, Signal Hill and the water front all visible by standing in one spot and doing a 360 degree turn.  One day we drove from the city down one coast line to the Cape of Good Hope.  Along the way we got to play with a bunch of penguins, probably Dawn's favorite animal, walk out to one of the Southern most points of the continent, drive back along the other coast line, and get back to town with just enough time to hike to the top of Table Mountain.  We were then able to enjoy a bottle of amazing South African wine (which is not only very tasty, but incredibly cheap) before taking the gondola back down the mountain.  It was truly a wonderful day!

Southern Tip of Cape

Train Car Hotel

After a couple more days enjoying the city of Cape Town we spent 4 days and three nights driving on the Garden Route.  Again, if you have not been here, it should be on the short list.  Our first night was spent in a train car that had been remodeled into a luxury hotel room.  It was sitting on a section of train track that is no longer used.  But the track 10 feet away from it is, so we did have to dodge a train on our way to dinner.  The abandoned track sits just off the beach overlooking the Indian Ocean.  It was a spectacular place, and I was able to take advantage of both an evening and morning swim!

Bloukrans Bridge - Bungee

Dawn on ostrich

After a long negotiations process, Dawn conceded to allow me to jump off of the world's tallest bungee bridge.  I know it sounds complicated, but in 2007 they held the Guinness Book of World Records for the worlds tallest bungee jump, but there is now has a taller one.  However; it is still the tallest bridge bungee, so the slogan had to change.  If you want you can check it out at:  http://www.faceadrenalin.com.  It was quite the rush with a drop of 709 feet, and the scenery could not have been better.  After the adrenalin subsided, we continued our journey to the ostrich capital of the world, Oudtshoorn South Africa, where we had an amazing cave exploring trip and got to ride an ostrich.  Ok, Dawn got to ride an ostrich, but due to my weight I was only able to sit on one.  But it was a pretty cool experience none the less.

We then started our journey back to Cape Town on what we were told is the longest wine route in the world, route 62.  We stopped at one winery for lunch, did a wine tasting, had an amazing lunch, bought a couple bottles of wine, and spent roughly $30.  For dinner that night we ate at an amazing steak house in the middle of the Stellenbosch wine region.  We shared a starter, both had incredible steaks, shared a bottle of wine, I may have also had an IPA, and the grand total was $50.  It is incredible how inexpensive South Africa is.

One of the many beautiful Wineries 

We spent our last two nights in Cape Town.  We were able to have a perfect last day before we had to wake up at 4am to catch our 6:30 am flight back to Malawi.  Seriously, for those of you who have been to Cape Town, you know that I have not even scratched the surface of how amazing this place is.  We are so thankful that we had the opportunity to visit, and hope that our future holds another trip.

Though this holiday season was tough being away from friends and family, we felt so blessed to be able to spend it with new friends, and have an amazing adventure that we will treasure.  Thank you for each of you reading this for being our friends and family, and know that you were missed, thought about, and prayed for during this Christmas Season!  God Bless you and Happy New Year!

Love,

The Kopps

Where we belong

We are closing in on four months in Malawi.  It is amazing how fast our time has gone, and yet these last few weeks have really made me realize how much I miss friends and family.  Dawn and I have been extremely blessed with the quick development of a great Bible study group, good friends, and invitations to lots of fun activities.  Still, with the coming and going of Thanksgiving, and Christmas right around the corner, we have realized that this amazing adventure does not come without a cost.

Before we left our home in Seattle, we were invited to have dinner with the Trotters, who are a couple who have known Dawn for many years.  Dr. Trotter and his wife spent a year in Kenya at Kijabe Hospital where Dawn spent two months when she was in medical school.  They have been good friends and mentors to Dawn over the years, and have also welcomed me into their home and lives. 

The Trotters gave me a few gifts to take to Africa.   One of the items was a book entitled “A dream so big” by Steve Peifer with Gregg Lewis.  For any of you who would like to get a sense of how things are in Africa, and the kind of work that organizations like the one I am working with (World Relief) are doing, this is an incredible read.  Steve Peifer was a very successful businessman in Texas, and had no desire to ever visit Africa let alone live there and become a missionary.  His wife had a lifelong desire to be a missionary in Africa, but God told her to put it on hold.  After the death of their youngest son (who was born with severe birth defects), they were deeply hurting as a family and decided to take a year to unplug.  They were given an opportunity to be dorm parents at a boarding school for missionary kids in Kijabe, Kenya (the same place where Dawn met the Trotters).  For the rest of the story you need to read the book.  Dawn and I have both just finished reading it and we cannot recommend it highly enough. 

There were numerous times while reading this book where Steve's words really resonated with me.  One example is that he would often say, “I am not a real missionary”, and “the real missionaries…” Most of those statements went on to describe how the parents of the students he taught were the real missionaries, and were really doing the work of the Lord.  That is often how I feel.  Though I volunteer for an incredible organization that is doing unbelievable work to care for the most vulnerable, I often feel like the people I work with are the true missionaries and I am simply blessed to be in their presence.  But I must accept that this is where the Lord has me, and He will use me if I let Him.  I don’t need to think of myself as an incredible missionary who is going to change the world, I simply need to be obedient and say yes to the Lord in each step, big and small.  That is what I am trying to do.

Last week, I found myself back in the very northwest part of the country in a district called Chitipa.  This is the area where we are working with a lot of local farmers (660 this year) to help develop a value chain for a cash crop called pyrethrum (a type of daisy used for natural insecticides).  It has been a really fun opportunity for me to work with an international team of men working to get this endeavor off the ground.  Through many Skype conversations, emails, budget renderings, the writing of an MOU (memorandum of understanding), and reworking of the budget, it looks like we are going to be able to move forward this year in our efforts to help change the lives of these farmers.  Being a volunteer, I am very mindful of the fact that this project will continue well after my time here has run its course.  So as much as my nature screams to take charge and take over, I have been having an incredible time being a member of the team and giving advice where appropriate.

Pyrethrum Nurseries (Dec. '14)

Pyrethrum Nurseries (Oct. '14)

Pyrethrum Flowers

Walking through a handful of nurseries that are growing the seedlings which will be transplanted into the growing fields during the next month, I took such pleasure in shaking hands and looking into the eyes of farmers who are working their butts off to improve their lives.  This is truly my reward!  Seeing the joy and hope in the eyes of people who have finally been given an opportunity to get out of poverty, and are willing to do anything to provide for their families.  I pray that those mental pictures of joy and hope never leave me.

We want to take this opportunity to wish you all a belated Happy Thanksgiving!  We are so very thankful for all of you who are doing so much to support us with your thoughts, prayers and finances, and friendship.  As we look forward to Christmas we want to again thank our Lord and Savior for the opportunity that He has given us to be here in Malawi.  Life here is not always easy or comfortable, but we are seeking to say "yes" to the Lord with each step.  Though we don't yet know the full purpose for this journey, Malawi feels like the place we meant to be in this time.   Please let us know if there are ways that we can be praying for each of you.

God Bless You!

John (and Dawn)

Not enough

I'm going to be very honest: I've been putting off telling my side of the story of our life in Malawi.  One reason has been that I don't want to mistakenly portray that working as a physician in a poor country is glamorous.  Most days I don't feel like I'm "making a difference".  Most days that I spend in the hospital are just plain hard.   I struggle against the pit in my stomach, my racing heartbeat, and the tears stinging at the back of my eyes to overcome a feeling that I can only name as "dread".  It's not that I haven't faced sick patients in a critical place before; it's that I haven't faced them with so little to offer.

The government maternity hospital where I work has approximately 40-50 deliveries each day, with 5-10 of these as cesarean deliveries (This is over 4xs the number of deliveries I am used to dealing with in my residency).  We have two operating theaters, but usually only one is functional at any given time.  And by functional, I mean that it has a table for the patient, a single dim light (when the power is working), a scrub nurse, and a nurse anesthetist.   It does not have suction (to clear the blood and other fluid from the operative field).  It does not have electrosurgery to cut through tissue or coagulate vessels.  It does not have any solution to scrub my hands or any sterile towels to dry them before we operate.  When a patient has high blood pressures (usually from pre-eclampsia, which is a potentially dangerous disease in pregnancy), we have only one medication that I used before in the U.S.  We only have one medication to treat postpartum hemorrhage (I am used to using up to 4 different medications simultaneously and/or a balloon device to stop hemorrhage if needed).  The hospital and the region's blood bank is usually nearly or completely empty, sometimes for days.  We are usually out of soap in the labor ward (the one bar is kept for "scrubbing prior to surgery").  Last week, we ran out of water making infection prevention all the more difficult.

In each of the 10 labor rooms, there are 2 cots.  On each cot, lies a laboring woman on a disposable plastic sheet that looks like a black industrial garbage bag.  There is no pain medication for women in labor and we sometimes are short on the anesthetic to provide relief during repair of tears after delivery.  The usual beat I am used to hearing as background music in U.S. labor rooms is eerily absent.  We have one fetal heart rate monitor among 15-20  women laboring at any given time and so we intermittantly use a Pinard horn to determine the fetal heartbeat in labor.  There is one infant resuscitation unit in the center of the horseshoe of these 10 rooms.  When I sit in a bench in the center of labor ward, midwives rush past me with their blue plastic aprons swishing to place a newborn on the resuscitation unit.  Sometimes the infant appears blue and lifeless when it is placed on the unit in front of me.  I find myself holding my breath as I wait to see if the mask with flowing oxygen will help this little one take its first breaths. I wish I could say that these limitations lead to the resourcefulness and innovation that saves lives, but often it is quite the opposite outcome.  The lack of blood products leads to women dying from anemia, the lack of soap leads to infections, and the lack of fetal monitoring leads to a missed fatal fetal heartbeat deceleration. 

 In addition to knowing that our facility may not have enough resources to offer our patients, I face my patients with the fear that I may not be enough for them.  I may not recall the right knowledge at the right moment.  I may not have the right surgical experience to quickly removed a massively ruptured uterus.  I may not be able to mobilize the right anesthetists, nurses, or other staff due to my lack of relationship or local knowledge. 

It is this fear that hits me the hardest, partly because it is true.  I am not enough.  I am not enough to save some my patients.  When I realize this, a piece of me begins to fantasize about moving back to the U.S. to work in the lowest risk, most technologically advanced hospital I can find.  (Another piece of me dreams about leaving the riskiness of medicine altogether).  Until I am hit over the head with this truth: I am not, nor will I ever be enough.  That is not my role and not whom I am called to be.  God is enough.  Only He is big enough to carry the terror, dread, hurt, danger, fragility, brokenness, limitations, and scarcity of the staff, women, and babies in my ward.  I am to relinquish this burden to the one who is made to carry it.  

This truth is freeing, but not always easy.  There is a piece of me that still wants to feel the joy for any success and the guilt of every failure as my own.  But in seeking God as my help, my source of strength, my wisdom, and my guide, both the lives and deaths fall on His shoulders.  They are big enough to bear both without breaking under pride or despair. 

So I choose to stay and walk back into the maternity ward on each call day.  As I meet each patient, I pray for wisdom in the decisions I make and for a deeper realization and trust that God is in control.  I am still learning and making baby steps (that are occasionally backward) in this process.  But I feel that God is using this time to ask me to trust Him moment by moment.  Recently in my study of Esther, I came across this encouragement from Beth Moore: "In the times of greatest struggle when you make the Godward decision over convenience, earthly comfort, or carnal pleasure you have come to a critical moment...a defining moment."  May a God who is enough for my patients and enough for me, find me faithful in these moments. 
"Trust in the LORD with all your heart; do not depend on your own understanding.  Seek His will in all you do, and He will show you which path to take."  Proverbs 3: 5-6

Thank you again for all of your prayers, cards, and e-mails.  Your encouragement means the world to us. 

A few photos from our hike to Ntchisi Forest last weekend.

Inspiring views both up...

And down.