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.

Traveling upward...John writes again!

 Today marks our two month mark of daily life in Malawi.  Our new rhythms have afforded us the ability to reflect a little bit about transition, adventures, unique experiences, and incredible work that the Lord is doing here.  That being said, we are still in our first couple months, and in many ways we are still in the honeymoon phase of our journey.  We have both heard that at some point we will hit a wall and start to really question what we are doing here.  We have been told to expect some extreme homesickness and really crave those things that we are not able to get here in Malawi.  Our hope is that in simply knowing that those feelings will be coming it will help to make them more bearable.  But for now, we are both still really enjoying the new joys and discoveries, and are very encouraged about how the Lord is using us.  Thank you God! Also, this is John writing again, just had to mention that so I could refrain from writing in the third person.


At the end of September, I was blessed to spend 10 days in the Northern Mzimba district of Malawi with an 8 person team from Grace Chapel in Boston.  Grace Chapel has been supporting the Mzimba district for the past 10 years.  Over the years as World Relief projects in what is now called "the old area" have become independent, and opportunities have developed in a "new area" in the district.  One of the members of the team (Joan) was on the original trip, and just made her third trip to Malawi.

Our time up north started out with three different teaching conferences taught by the team that ran for three days.  The first was a pastors conference that consisted of 37 different pastors from a new area that World Relief Malawi is reaching out to in the district.  These pastors were all from different churches and encompassed a wide range of denominations (Presbyterian, Pentecostal, Roman Catholic, Assemblies of God, etc.). It was an amazing conference that was lead by two pastors from Grace Chapel, and really dug into some theological training around caring for the most vulnerable in their communities.  Obviously the different denominations have some differing theologies, but they were all able to come together in the name of Jesus.  Additionally, many amazing relationships were built in such a short period of time.


The second conference was a youth conference that was geared towards teaching youth (ages 15-25) how to be leaders in their communities.  This group also came from the new area that World Relief Malawi is reaching out to.  The conference drew 26 youth and three elders from different churches who also wanted to see what the youth were learning.  The conference was lead by two members of Grace Chapel who work with youth back in Boston.  Their enthusiasm and passion for this
age group really came through, and the youth really fell in love with them.  They taught on issues of self confidence, self worth, being role models, HIV/AIDS education and misconceptions.  I was struck with the reality that youth have the same struggles everywhere, whether it be in one of the poorest countries of the world, or the richest: smoking, drinking, sex, peer pressure, and lack of direction. 

A third conference was geared to the teaching of caregivers. The Malawi understanding of a caregiver is a man or woman who works with primary school kids (age 6-15).  Thirty-two care givers came from the old area where World Relief has been working for about 6 years.  It was incredible to see the difference in the old and new areas in the district.  The caregivers from the old area have fully bought into the work that World Relief is doing, and they are eager to learn anything and everything so that they can turn around and teach their students.  The day I was able to attend this conference I was privileged to watch 4 different group do skits, traditional dances, and singing as a way to say thank you for all that was being done for them.

After the conferences came to a close, the team moved onto visiting both the both the old and new areas.  We first went to the new area and were able to see a couple of seed projects that were being done by local churches.  When World Relief Malawi moves into a new area of ministry, they reach out to local churches, pastors, and community leaders (often village chiefs).  In order to then get church buy-in, then they request that the church does a seed project to show their willingness to care for their most vulnerable in their community.  We were able to witness three of these seed projects.  Each community gets to choose what they would like to do for their project as World Relief does not want to dictate what they have to do.  In each of the villages we visited, the church had decided to build a house for a person or couple in their congregation who could not take care of themselves.  It was truly beautiful to watch how these churches are learning to care of "the least of these".  The homes are very basic: brick walls (often covered with a mastic or stucco type surface), thatched roofs, and baked dirt floors.   As a part of each of the house visits the World Relief team had put together small gifts to give to the recipients of the new home.   These gifts included a plastic bucket that they could fill up at the village well to bring water back to their home, a blanket, sugar, soap, and salt.  These gifts, though basic in our eyes, lead to celebrations, singing, praising of the Lord, and on a couple occasions the entire community broke into song and dance as they were filled with so much joy for those receiving the gifts.  There is no way I can do justice with words to describe what it was like to witness this.  It was truly a blessing. 

Over the next couple days we were blessed to spend some time in the old area.  This area has been worked with by World Relief for 6-10 years.  And many of the villages are reaching the point where they are able to be fully self sufficient, and are allowing for the resources of World Relief to branch out to other areas in the district and start new areas.  These villages have successfully implemented all of the teachings from World Relief and are fully caring for their communities both financially and spiritually.  They are running successful village savings and loans groups, agribusiness groups, CBCCs (Community Based Child Care Centers), and support groups for those living with HIV/AIDS.  It is hard to find words to describe the hope that these villagers now have because they have learned how to work together as a community and take care of their most vulnerable.  They have hope, they have life, they have pride because all that they have, they have worked for.  World Relief has provided the training, and in some cases some assistance in starting programs, but in each and every case that assistance is then paid forward to other communities to also help them get off the ground.  I have a whole new respect for helping the most vulnerable help themselves.  World Relief Malawi is not giving these people money, they are giving them education and training in order for them to do it all themselves.  They have taken ownership, they have rallied around each other, and they have fully given their lives over to the Lord.  So amazing!



The team ended their time with a full day at Lake Malawi to start to unwind and process.  We had a great time of debriefing and relaxing together as they prepared to head back to their families and lives in Boston. I was very blessed to be a part of this trip.  For those of you from the trip who are reading this right now, thank you for allowing me to be a part of your team and experience the ways in which the Lord used each and every one of you!

Thank you all for all your thoughts, prayers, and support.  We are truly blessed. 

John Kopp
(P.S. I promise to make Dawn write the next post so you can get a different perspective of our life here in Malawi).  

Here, there, and everywhere: World Relief, Kuti Nature Reserve, and Lake Malawi

First and foremost, we are sorry that it has been so long since our last post.  My mother keeps reminding me at we need to write more often, thanks mom :)

Our first month in Africa is now in the books, and it really has been an amazing experience so far.  Dawn is starting to settle in with work and research.  On Monday she will work her first clinical day, and though she has already been involved in multiple surgeries here, this will be her first time being responsible for her patients.  This is something she is both excited about, and terrified at the same time.  For all of us who know her, we know that she will be amazing, but she is still nervous about it, so please keep her in your prayers!

Last week I was given the opportunity to spend a week in the villages of the Salima District of Malawi with a 5 person team from the United States.  World Relief looks for partner churches that in essence sponsor a district of the country.  World Relief Malawi has four partner churches that each support one of the four districts that we are currently working in.  The Summit Church of Orlando Florida is a new partner church with World Relief Malawi, and I was able to be on their first ever mission week.  It was a great experience for me, because it was also my first time being out in the field and seeing the ministries that World Relief is involved in first hand.  We were able to see lives being changed in so many ways.  People there are living with HIV/AIDS who are supporting one another and choosing to live life to it's fullest.  Orphans and other vulnerable children (OVC) are being partnered with local artisans (locals who have a specific vocational skill: tailoring, carpentry, baking etc.) as apprentices and given the opportunity and training to start their own businesses that are sustainable in their own village.  

We were also able to sit in on a "Savings for Life" group meeting that teaches villagers how to save their own money, no matter how little there is, and allows them over time to create enough group money to start loaning it out to each other to start small businesses.  The beauty of the program is that there is a 30% interest rate charged on the loans (maximum of 3 month loaning period), and all of that money is put back into group account.  At the end of a year all of the money is given back to each member at the percentage that they invested.  Only members of the group are able to take loans, and only up to three times the amount that they have invested.  Often the first year or two does not give the groups a lot of income, but at a minimum it teaches them that they can always save money, no matter how little they have.  After the second year, and into the third year is when the members really start to see their money start to make them money.  The group we met with more than quadrupled their money in their third cycle (third year).  Being a money and numbers guy, this program really blows me away.  I love that these villagers are creating money out of their own money.  World Relief helps through education and consulting, but they do not contribute any actual money to the program.  So every penny (or, more accurately, Kwacha) that they make has all been contributed by the members themselves.  It is so amazing to see how empowered these men and women appear.  I witnessed the sense of accomplishment they have in knowing that they are paying for their children to go to school, putting metal roofs on their house instead of thatch, and starting to look at ways that they can give back to their villages on larger scales.  It was incredible to learn about and even better to witness a few of the lives changed by this program in person.  

The group from Summit Church are all part of a ministry called reGroup in Orlando.  It is best described as a cross between a 12-step program and intensive counseling sessions.  Their hearts were naturally drawn to the HIV/AIDS support group and wanted to spend the majority of their time working with that group.  World Relief has developed a project called "Memory Books".  For three days, men and women in the support group teamed with mission group members spending three days collecting information about their families, delving into personal questions, and creating a written document of who they are and what they have overcome to be passed on to their children.  It really was a heartwarming experience to see these men and women be able to tell their story, and fully understand that this is a book that they will get to keep with them forever.  Here is an attempt to upload a video of them dancing and singing in celebration, it really does melt the heart (if it works; and if it doesn't you may have to use your imagination)!  

After 5 days out in the villages, Dawn and I were able to slip away to Cape Maclear with is on the Southern tip of Lake Malawi to celebrate our 2nd anniversary.  While waiting for friends to drop her off, I was able to spend a few hours in a small nature reserve called Kuti.  It was just 10 minutes away from the lodge that the team and I stayed in for the week.  I will let the photos do the majority of the talking.

In Cape Maclear  we were able to stay in a simple bamboo walled villa that was 20 feet away from the water.  We were able to watch three incredible sunsets, awake to coffee and tea delivered to our porch every morning, walk 20 yards down the beach to an amazing restaurant andlounge where I was able to eat one of the best burgers of my life (okay, so I ate that same burger twice, but it was SO good!)  In addition I was able to get two scuba dives in.  One was down to about 30 meters where there was an old sunken yacht apparently sunk during war time.  Still don't quite understand why a pleasure craft was sunk during a war, but they were sticking to their story.  For all of you out there who have asked for updates on the cichlads (pronounced siklid), they are all that they are cracked up to be.  They are small fish, but as colorful as any fish I have ever seen.  My favorite was a black and white striped one that I called the "Zebra fish".

 Thank you all for your continued thoughts and prayers.  We have really enjoyed our time here so far, but we have also been told that no matter what, at some point we will go through a period of missing home, and questioning our decision to move so far away from the familiar.  It has not happened yet, but we also want to be mindful that there may come a time when all is not just a big fun adventure.  So we would continue to ask you to be thinking and praying for us.  We hope that this finds you all well, and please know that we would love to host any of you who would like to come and experience Malawi!

God Bless,

John and Dawn Kopp

Taking our first steps

Eleven days ago, John and I have started a journey in which we know we won’t emerge the same.  But really, this journey did not start the minute we boarded our first flight out of Seattle.  God has been directing each of our steps down paths that eventually led to a common path together.  And as we traveled together, a common desire to see the world through God’s eyes was formed.  This blended with a longing to use the abundance of opportunity, gifts, and talents we have been blessed with to serve the world.  And mysteriously (to each of us, but not to many that know us well), Malawi emerged from this strange recipe.  Malawi: a place, a calling, a people, a country. 

I suppose I should start with the professional reasons (or excuses?) for what has brought John and I to live in one of the 10 poorest countries in the world for the next 2 years.  I (Dawn) have begun a 2-year global women’s health fellowship through the University of North Carolina (UNC).  UNC has been working in Malawi in some capacity for 24 years.  I was drawn to pursue this opportunity as it provided a chance to work as an Ob/Gyn and explore research in a international setting with on-the-ground mentors.  I have long felt that the opportunity to become a physician was given to me to use my skills and education with women in parts of the world who struggle against enormous obstacles to remain healthy mothers, sisters, wives, and daughters.  There is a part of me that lights up with joy while treating patients overseas.  Perhaps it is part conviction at righting the inequality of the chasm between the wealth into which I was born and the poverty before me.  Perhaps a part is my love of making connections with others across cultural or ethnic barriers. Perhaps it is part calling, discovering a piece of God’s purpose for my life. 

John’s work in Malawi stemmed from seeking a way to serve and empower locals in a personal way.  He is excited to meld his desire for Christian ministry and skills in business and communications with World Relief.  The organization seeks to empower local churches to serve the vulnerable in their communities.  Since arriving in Lilongwe last week, John has enjoyed being the only non-Malawiian in his office. His colleagues have been quick to help him expand his Chichewa vocabulary (the language spoken in Malawi), teach him how to eat nsmia (the staple food in Malawi), and introduce him to how dress “smartly” (his boss regularly wears a 3-piece suit to the office). 

The first week has had plenty of practical adjustments beyond the understanding of what our jobs entail.  After 44 hours of travel, we arrived in Lilongwe, the capital of Malawi on August 8^th.  God answered prayers to help us get our visa less than 48 hours before our flight, which got us get through customs.  We had received a small moving allowance and spent the past month paring down our belongings for the next 2 years into 11 bins and suitcases.  To my disbelief, every piece of luggage arrived with us and intact.  UNC has guest housing for those taking short term trips and we started our transition in the “surgery house”.  There is a couple (Jared and Laura) from UNC who are running this house for the year.  We have loved getting to know them and their 2-year-old son.  Jared is a general surgery resident and Laura is a social worker in a pediatric HIV clinic at UNC.  John has enjoyed walking the house guard dog, ZaZa, in the evenings.  We have both enjoyed Laura’s “everything from scratch” cooking.  The guest housing arrangement felt like a perfect fit-to the point that we don’t feel ready to leave anytime soon and have made arrangements to stay until December.  In December, we will move next door into our own 2-bedroom house in the same compound.  Community living has thus far included sharing coffee in the mornings, story times with our favorite 2-year-old, a trip to the beach, exploring local churches together, meals, card games, and Seinfeld episodes.  We are excited to see the many other ways we will grow as individuals and as a couple through our relationships with the travelers in our house. 

We have just begun to travel (on the left side of the road, of course) in our new country.  Though the roads are dusty with plenty of potholes, they have led us to hear local musicians, experience passionate worship services, travel to the beautiful Lake Malawi, visit new friends’ homes.  We can’t wait to see where the road leads next.  We love you all and are so grateful for your prayers and support. 

Photos: 

Above-John and I happy to be in Malawi while waiting in line at Customs

Below: All of our luggage finally packed the night before we left Seattle, A potentially prophetic sign at the Addis Ababa airport, Laura with one of our amazing community meals, John relaxing during a day trip to Lake Malawi

What will John be doing in Malawi?

We've gotten this question a few times.  No, John will not be a stay-at-home husband.  He will be working with World Relief Malawi as a communications and business development volunteer.  Below is a link to a page that explains a little bit about how this journey started for him and an opportunity  to provide support.
World Relief: John Kopp

We're moving out!

On August 6, Dawn and John will begin their adventure to Malawi.  To follow along in this step of their journey, you can enter your e-mail with the link on the right to get updates.