Blessings Hospital and Malawi's Economic Tsunami

  

Economics, the course I found most difficult to comprehend in my studies at Harding University, is having a devastating impact on Blessings Hospital. But, there are some pretty simple economic truths that did make sense and stick with me until this day, most of which my Daddy taught me before I got to Harding.

1. You can’t spend money you don’t have.
2. Loans cost more than savings earn (bankers have to make a living too).
3. When the government prints more money, it is relatively worth less.

And now, a brief summary of the economic chaos which is Malawi today.  For some years Malawi has been very dependent on outside donors for the normal operations of government, not just special projects.  Forty percent of normal budgetary operating expenses are paid for by outside donors, with England leading the way.  In August or September, while the president was out of the country, a high-ranking budgetary official was shot in the face about midnight one night as he was waiting for the gate to his house to be opened.  Other high-ranking officials were accused of being involved in this attempted murder.  

Shortly after this a series of low and high-ranking officials were found to be in possession of rather large amounts of cash, extravagant houses, or other things far above their means  for which they could not account. Now, after some weeks of international forensic auditing, it has been announced that $34,000,000 either disappeared (half of it) or was grossly misused by government officials in the six months ending in the shooting.  England and the European Union cut off all aid to the country in anticipation of this result, gutting that 40% of the country’s operating budget.  

The value of the Malawian currency, the Kwacha, has plummeted, going from a fixed rate of 150 per dollar to a depth of 430 per dollar in less than 2 years.  The troops in the trenches were pressed as salaries decreased in buying power.  Some non-governmental international aid organizations (NGO’s) were able to make salary adjustments to the extent their income was in dollars, but government no longer had such a luxury.  Even the cost of corn soared as the fuel to transport it and grind it climbed in price. Workers became very restless.  Something had to be done.  So, the government gave all its employees a 50% raise.  

This eased the cries of the proletariat, but . . . where did the money come from?  Within a few months reports began to leak out.  A friend working in a government clinic told me that at their site, the only medicines which are available are contraceptives, malaria medicine, and meds for HIV, all of which are supplied through special projects mostly administered through NGO’s without the government touching the money.  Other departments reported workers sitting in their offices unable to do their usual work due to no tools or ability to take a departmental truck into the field.  The one department that seems to have increased activity is the Malawi Police Force:  I have never seen so many police on the highway handing out fines newly increased from MK 3000 to MK 5000.

The effect on competition for workers with the private sector has been devastating.  Due to chronic shortages, the government and mission hospitals have not quit hiring medical personnel.   Mission hospitals (called CHAM hospitals for their membership in the Christian Health Association of Malawi) have been relatively protected because their clinical personnel are paid mostly by the government.  One large mission provider recently reported that 40% of its income comes from the Malawi government, 40% from donations from outside the country, and 20% is generated from church contributions within the country and from hospital revenues.    

Blessings Hospital is in trouble.  We are running out of nurses, and are unable to hire others at our current salary level.  The administration is working hard to become a CHAM member, but it is estimated that the process will take 2 years.  Most of our operating revenue comes from the care we deliver.  Our census is rising.  The number of people we are helping is going up.  The number of babies born in our facility is increasing.  By the grace of the Sara Walker Foundation we are visiting an increasing number of villages with a mobile clinic, villages that are far from medical care whose only transportation is a bicycle.  The same vehicle makes it possible for us to carry patients who need it to a higher level of care. 

Our biggest acute problem is personnel salaries.  We need to give our workers a generous raise.  We need to hire others.  Desperately.  We are living off per diem nurses who earn less, mostly government workers who are willing to double on their vacation days.  But, the time when most people take vacation is about gone, and our needs are increasing as our nurses leave.  

If you would help us raise a nurse’s salary up to a minimum level, or even explore a partnership like that for one or two years as we process our CHAM papers, please contact me at brucesmithmd@gmail.com  We will be happy to share further details with you and explain how to process your tax-deductible contribution so that it can be used most effectively.  Learn more about Blessings Hospital through her Facebook page, or for a tour of the hospital, click here.

Ox-Cart Medicine

For some time the staff at Blessings Hospital have longed for the security of an ambulance with dedicated driver to provide a means to transfer complicated patients to higher levels of care.  This prayer was answered in January by the Sarah Walker Foundation with the equipping of a used Land-Rover Defender (the famous, nose-down box that never quits) and the hiring of a driver.  This vehicle does many duties, one of which is to carry a clinician to outlying villages within our service area, where local churches offer their building as a clinic site, and then work with the chief and their neighbors to spread the word insuring that patients come.

Yesterday the clinic was at Chimbwala, some 20 km /15 minutes away.  It was afternoon.  The clinic was finished and the driver and clinician were packing up their supplies to return when an ox-cart was noticed  moving unusually slowly toward the church building, but there were no oxen!  Instead people were struggling, 4 pushing the yoke and 6 pushing from behind, to move the cart along.  In the cart was a young man who was seizing.

The patient had complained the day before of body aches and fever, but people had ignored him.  He wasn’t much better when he woke up the following morning, and in the afternoon he stayed home while everyone else went to a soccer game with a rival school.  When his family and friends returned he was unconscious and seizing intermittently.

Lacking IV supplies, the decision was made to hastily move the patient to Blessings.  Not too long later Harold Banda, our administrator (himself a nurse-midwife), and William Banda, our nurse on duty at the time, were chatting on the front veranda when they noticed the ambulance careening around the corner into the hospital grounds, lights on, flashers blinking.  (We don’t yet have a siren or true emergency lights on the ambulance, and they were sorely missed as the driver worked his way down Malawi’s principle artery in the late afternoon traffic which was returning to the capital).

William started back into the hospital thinking it was a ruse, but Harold urged him to wait and see: maybe there really was an emergency.  The staff on board hopped out of  the ambulance almost before stopping and related the essentials.  As they opened the back door to extract the gurney, the patient was seizing.  He had not regained consciousness since they first saw him.  The patient’s wife and friends shared the history, and  malaria, the most common illness in Malawi and one of the major killers, was immediately suspected.

Harold (who doesn’t regularly work clinical shifts) joined William in getting an IV started.  Some blood was sent to the lab for malaria testing, and IV Valium was pushed to stop the seizure.  Ceftriaxone was pushed as per Malawian protocol in case of bacterial meningitis, and then the malaria rapid test result returned:  Positive for malaria antigen.  IV quinine was begun, and the patient later awakened.  

The following morning a man walked into the hospital entrance, and he and Harold recognized each other immediately:  He was Harold’s head teacher in secondary school.  Questioning the occasion, Harold was

The "Man in the Oxcart"
thanking Dr. Harry.

told by the visitor that the malaria patient himself, also a teacher in the village where the clinic was held, was his younger brother.  The patient felt much better that morning, was awake and taking food and oral medicines, and was discharged with his wife and brother to finish a three day course of oral meds for malaria at home.  As is customary here where transportation is often a barrier to care, he was returned to his home in the ambulance.  

Medicine, perhaps especially in Malawi, at times presents occasions of great grief, futility and frustration.  Malaria can be stamped out, as it has in many countries, if the political will exists at national and local levels, and if enough resources are applied to the task.  South of the United States, for example, in two very different countries politically, Costa Rica and Cuba have eliminated the scourge, but they are the only ones.  In spite of the many frustrations here in Malawi, there are thankfully also occasions where all hands, including the neighbors,  do their parts well, everything works like it is supposed to, and potentially tragic or fatal situations are redeemed to life, joy, and ongoing service.  

Perilous Passion

“Is he always this passionate?”

The inquirer was making a site visit from the Department of Health and Human Services, Maternal-Child Health Bureau, checking us out regarding a federal grant we sought. The question was rhetorical, more a commentary on my exuberance and enthusiasm regarding the needs of women and children in San Bernardino County and our proposed solutions than a request for information, but the answer Vanessa Long, our most capable program manager would have given was a decided “yes”. Today the answer haunts me.

My just-completed four days in an excellent South African hospital revealed several key pieces of information about me and my little stroke. First, there is no evidence that the stroke was caused by a clot or bleeding inside the brain. It was deep in the brain in an area called the thalamus, not on the surface as many more debilitating strokes are. Speech and thinking are not at all affected, thanks be to God, and there is little if any weakness. I’m numb on the left side of my body and a little uncoordinated on the left. And my head feels spacey (good medical term, “spacey”). While there’s no plaque or fat deposits in the walls of my arteries, their muscles are thicker than average. But the most important information was that my blood pressure tends to go through the roof (192/106) under any emotional situation, positive or negative. The nurses caught it up there several times, though 130/80 was more common. The high pressure probably caused spasm in a small penetrating artery serving the affected area leading to hypoxia and maybe then “terminal” spasm. Intense reactions to normal stimuli? Perilous Passion!

The passion that got me here (“Something has to be done to help our brothers and sisters in Africa deal with HIV.”) could well take me out. And yet it has always created difficulties. Beginning probably in grade school, some of you will remember the kid on the front row who got C’s in conduct in part because his hand insistently waved to answer every question. That passion has suggested to some that emotion has clouded reason, though I think it usually follows a reasoned conclusion. Some people resist the causes that passion supports just because of its intensity. “For every reaction there is an equal and opposite reaction,” and that may be true even within the body of this passionate individual. The current question is whether that passion can be controlled, modulated to avoid its destruction of the body which gives it expression. Putting it in a box will not likely serve its cause.

A few years ago I was invited to a prayer retreat put on by Randy Harris, Rhonda Lowry, and the then youth minister at the Malibu Church of Christ. It was to run from early Friday evening until Sunday afternoon. Getting across the LA basin took more time than I had allowed, and the retreat was beginning as I turned off Interstate 5 and headed into the Santa Monica Mountains. I relished the challenge of the mountain curves in my Honda Civic with the V-tech engine, and I got there, stoked, ere long.

What I remember most of the retreat was my feeling at the end after nearly two days of mostly praying, together and alone, with a little talk of prayer and meditation sprinkled in for guidance. First I didn’t want to leave. The place was not of paramount importance, but the rural setting was conducive to our goals, and the things that normally intruded were not there, so I loaded my car after lunch on Sunday so as to prolong uninterrupted the open-ended afternoon session in solitary prayer—just me and God. When I finally did leave, I felt no reason to rush, so no screeching of tires or exhilarating turns going down the hill, quite in contrast to the drive up. I felt no pressure to get home, not just because I had no appointments that evening, but none of the usual pressure that appeared within me raised its ugly head, created by my own internal demands to be busy, to do something. And so I was content to stay amongst the big rigs at 55mph easing down the interstate toward LA in the right two lanes. I was at peace. I was convinced of the value of what we had done, but I was contrastingly almost reluctant to speak of it. That passion was somehow different.

That peace remained largely intact through the night. I made some changes in my behavior that were suggested at the retreat, spending more time in the Word, especially the Psalms, changes that have been largely maintained to this day. But, those things gradually became one more part of the “to-do” list, the must do list and over a few weeks that deep inner peace gradually slipped away, crowded out by the press of a plethora of commendable activities, unprotected by my reading of the verses in the Psalms.

Today I am convinced that what happened at that retreat is a big part of the solution to the problem my self-destructive body is presenting. Don’t get me wrong. I am quite aware that we all must die, but 60 is relatively young, even (or maybe especially) for our family. In addition, more than sixty years of resistance training for my arterial muscles probably will require medication to assist in the task of keeping the BP down (and I’m on it), but learning to approach life on a little more even keel will probably reduce that medication requirement, and medication alone probably won’t do it. Finally, it was and is a good thing, that peace, in and of itself, and my colleagues in the kingdom would probably get along better with a Bruce no less committed but with a little less edge.

Death of a (small part of the) Brain, Observed

I suddenly felt light-headed and my left hand was tingling, then my toes. I was sipping a coke at one of our favorite cafes, waiting on my lunch. As they brought Beth’s plate, then mine, I shifted my weight, moved my shoulder, but it got no better. The left side of my mouth felt like I was at the dentist, but also the rest of my left face, top, middle and bottom (that’s not supposed to happen). There was no headache. Something was amiss, terribly amiss inside my head. A parasite (I recalled that pork kabob at Momma Mia’s, a little too rare, about a year ago) or a tumor had decided to manifest itself, or I was having a stroke. My left arm felt heavy, wanting to fall to my side, and when I eventually tried to stand, I had trouble walking. I needed help to stay on my feet.

“A stroke?! I’ve no risk factors for stroke.” My mind rebelled against the reasoned judgment of my new friend and colleague Jerry Koleski whose number I had at hand, an American internist at Partners in Hope hospital, a major HIV project in Lilongwe which helps with other medical needs in some circumstances. Denial was working hard, but my entire left side was still tingling. Lunch in Lilongwe was being interdicted by life, or maybe impending death. The owner of the Cappuccino Café rushed for aspirin suggested by my doctor friend who called back as it arrived: “Don’t take it. If you’re bleeding it’ll make it worse. Come on over to the house. I’m just three blocks away.” After an exam confirmed his suspicions of probable stroke, several hours of negotiating with insurance companies, led by Jerry’s wife Elizabeth helping Beth, an air evacuation to South Africa was arranged as Malawi didn’t have what we needed. It would be no less than 12 hours later and maybe as much as 22, but it all fell through when the chosen company called at the hospital late that night to say they didn’t work with our insurance company. Our missions minister visiting Tanzania en route to see us the next day with his wife and children got on the web (to which we had no access) and got us tickets on the commercial flight the next day at noon.

The 3 hour flight was relatively uneventful, and wheel chair assistance whisking through all immigration and customs stations got us into a taxi and out to Milpark Hospital the Malawi-based docs had used several times. An MRI followed our ER visit, confirming the stroke, an area of tissue about the size of an olive in the brain’s right thalamus being affected.

A stroke. Part of my brain dying, starved of blood, glucose and oxygen. How much will I lose? Is my work finished? I’ve not really gotten started. Am I finished? Will it get worse? Will it get well? Lord, what’s up? Why? What will I do? Will this eventually help in some strange way with what you want me to do? As we’d gotten into the car that first day to see our friend I’d given Beth messages for our children. As I went to sleep that second night I again had a little talk with the Lord. I knew he was there, but like Jonah, who didn’t find the presence of the Lord as manifested in the storm or the fish too comforting, I didn’t either. I thought my wife would've been more comforting, but she'd gone to stay with other new friends in Johannesburg.

I’m out of the hospital now. I’ve had a “lacunar” stroke, deep inside my brain. They often leave no symptoms (at least with the first one), and I’m walking better, but my whole left side is still tingling, including my left chest and belly, front and back. I’ve learned that my blood pressure tends to go up really high when I’m stoked or stroked. I’m on some meds for that, and one aspirin a day, though there’s no evidence that a clot played a part in this one. I left the hospital two days ago, and will fly to Malawi tomorrow, God willing.

I have no more idea “why” this happened than when it first began, but I am much more aware of my dependence on God for everything, including this breath. I am more humbled as to my place in the universe, and the importance of “my plans” in the will of the Lord. While I have no doubt the Lord is willing to work with me, to use me, in fact is working with me and using me to bless others through me, aware that I can and do have some part, however small, in the cosmic story he is unfolding, I am also more aware than ever that he doesn’t really need me. He is not dependent on me to complete the story or even to do “the task” that I’m currently called to do. Rather when he calls, my task is to answer “yes” to whatever he wills, even if the call is, “Come home.” If nothing else, I’m much more aware that, as the hymn says, “Today I’m nearer to my home than e’er I’ve been before.”

Welcome Home!!!

We’ve been in Malawi less than 24 hours, and it’s good to be home.

We arrived at 2:00 PM yesterday, Thursday, February 17, 20 minutes early. A good start. All our bags arrived. Another very good start! This was the first time all our bags had made the transfer in Addis Ababa on these flights. The new Ethiopian Airways schedule with a slightly longer layover in Addis is working. Napoleon and Gracian were awaiting us. Also very good. It is so good to see them again. Welcome home!

A few hours after arrival we thought of supper but were told that the propane tank was empty. We had failed to blow out the pilots before we left (a mental note for next time), but after several meals on the plane we weren’t too hungry. We not uncommonly eat cold cereal in the evening, and there was some left and waiting, along with liters of long-shelf-life juice and soy milk. It was all good. We found some gas in the tank at the guest house, and swapped out the tanks for the moment. The first run to town would have to include a bottle of propane. Welcome home!

As we headed for bed, we discovered that the electricity had gone out in the back half of the house, at least most of the electricity. Beth had turned on the bedroom water heater and left it longer than usual. We found all the plugs in the bedroom and all the lights that are switched in that room out. One light, switched in the adjacent family room only, was still working. I tried the circuit breakers, and one, when turned off and back on restored the current. But sparks flew when I switched it either way. We left the breaker off, hauled out a transformer and a long extension cord and rigged up 110 from the front of the house into the bedroom. The fan and C-PAP worked fine. (I’ve used C-PAP effectively every night for the last—well, nearly 20 years—to counter sleep apnea.) We could sleep. Welcome home!

We took melatonin at bedtime around 9:30, at the suggestion of fellow-travelers (where do doctors get their continuing education?) confirmed by Beth’s pediatrician brother. It’s apparently great for helping kids and international travelers get their days and nights straightened out. At some time between 2 and 5 AM I awakened, took two or three long, deep breaths through the CPAP mask and dozed off again, only to reawaken almost immediately and repeat the process several times. Finally I was awake enough to realize that the electricity had gone off—all of it, all over the house. The C-PAP mask was now doing more harm than good, so off it came. But the melatonin and fatigue danced well together and after shedding the mask we woke up much refreshed at 8:30—11 hours sleep. Welcome home!

It’s rainy season, and despite the roof patching done in December just before we left, wet spots are still appearing in the ceiling of the bedroom—not as bad as it was, mind you, and not coming through on the bed; just keeping us alert to the unlikely possibility. It’s been this way for years, leaving stains throughout the house, and black mold penetrating the ceiling in a few. We hope to change the ceiling, once we get the leaking under control, when we get the leaking under control. But the bedroom still leaks. Then at mid-morning it really started to rain, a gully-womper. The wind wasn’t that high, but suddenly, water was gushing down the inside of the front wall and window, soaking the curtains and the floor. It did this one day last year when we had first moved here. I knew the patching of nail holes through the zinc sheets wasn’t going to handle it, and it hasn’t. We’ll have to look at that design problem in the attic where the roof meets the porch overhang and rethink this once more. Hmmmm. Welcome home!

The electricity in the back of the house is out again, and a closer look with the campus electrician reveals a wire too small going into a circuit breaker. The breaker didn’t fail primarily, but where the inadequate wire was burned at entry to the breaker, the breaker is also burned, ruined. A new one will be necessary. Welcome home!

We needed to let Wes know we had arrived safely and well. There is no internet access at the house today. At the airport the signal strength is uncharacteristically weak. But Beth got on and the message is sent. We are well. Welcome home!

There was a quarter tank of diesel in the car when we checked. Napoleon had told us there was a severe diesel and gasoline shortage. We’d read about it in the States. A demonstration had even been planned for the 14^th, but it had been thwarted by the police who’d picked up the organizers at the meeting site. Now we needed diesel. Napoleon instructed us: “If you wait on the diesel, you will never find it. If you go looking for it, you may not find it. But you have a quarter tank. You can go to town and back twice, if you don’t drive too much in town.” Welcome home!

We went to town, and asked at the first station—“No diesel or petrol.” Two semis waited at the second station for a delivery at some time in the future. A few trucks and buses were taking on fuel at the third station, but they denied us service; limited supplies were only for their big corporate customer. At the fourth we tried there was none. “Try the total at Maula.” As we neared, the line was evident, so we lined up, about ten or twelve cars back. One truck carried a very large tank on the back, several hundred gallons. Would there be any left when we got to the pump? Harold (the hospital administrator) walked off to take care of his business in a nearby part of town, and returned. We were next, and then we filled up--both tanks, enough for possibly two to three weeks if we are careful. Welcome home!

As we waited in the line for diesel, a European whose pick-up was in front of us walked back to chat. He was a Dutchman. He had driven from Rhumpi in the far north of Malawi that morning to attend a meeting scheduled for 4:00. He had found no diesel between Rhumpi and Lilongwe. Would he get through the line in time to make his meeting? We learned that he is a doctor, having worked as a medical missionary in Malawi for about 17 years, including one stint on an HIV-related public health project. All medicine in Malawi is HIV-related, but he is now attending in the public hospital in Rhumpi. “Churches are not doing near what they should be doing to combat HIV,” he noted, blessing our plans. He told us of a bi-annual meeting in Kenya hosted by the American Christian Medical Society, two weeks long, granting enough CME credits for two years’ requirements. It will be held in February 2012. We exchange contact information. Welcome home!

Out of propane. There's an extra bottle at the guest house.

Electricity problems. Our electrician friend is on campus.

The roof leaks. But less than before, and only rarely reaching our feet (or even our heads!)

Internet hard to get. But it will be better with a latte at the hotel (and it was!).

Vehicle fuel shortage. Two full tanks after only an hours’ wait—and a new colleague and encourager to boot!

Within a few hours’ time we are reminded why we looked forward to an “escape” to the States. But the reasons we were ready to return--the things we missed about Malawi--are still here, most of all the dear friends we made during the past year. And so we wander from here to there, thankfully never completely satisfied until we reach the home prepared for us and hear the words of the one who guides us from here to there: “Welcome home!”

Going Home

The sun is probably well above the Doa Mountains by now. My friends the guards, Moses, Wilson, Kay, McNight, and others have long left their posts, are probably eating breakfast by now, and may be soon returning for some piece work on Saturday. Florence and Mtami would be coming soon for their occasional visits to the house in our absence, if today is the day. It could be raining hard, or have ceased after a steady rain through the evening, or be the day this week when the sun will shine. Whichever is possible as we enter the heart of the rainy season, and I hope the patches applied to our roof just before we came here are holding up well, and that those which seemed less than perfect have not become a fountain into our bedroom and down on our mattress.

I am sitting in a men’s retreat at the YMCA Camp Chandler on Lake Martin just north of Montgomery, Alabama. It’s 10:30 or so, and my mind has wandered to now’s early morning in Malawi. It is good to be here with a bunch of men, about 80, who are dedicated to following the Lord, all from the Landmark Church that is our primary sponsor in Malawi, but time to return home is approaching and my thoughts slip smoothly between the comforts and challenges of the present and those to which we return in Malawi. It is cold in middle Alabama tonight, but the room is warm, and the husky singing of this male chorus is encouraging. It is one of many other beloved and caring “suitcase stops” on this six week visit in the U.S. These faces have been a blessing, as have all that we’ve seen while home, kin, and kin in Christ, encouragers all, each in his or her own way. Folks in L.A. and Redlands, those from all over in Dallas at the medical missions seminar, in Kilgore and Shreveport, Jonesboro and, again from all over, in Searcy, now Landmark in Montgomery and University Church in Tuscaloosa next week. Then home.

Home. The U.S. is home. Malawi is home. Which is really home? Or, which is more “home” right now. For all the wonderful hospitality and welcome oh-so-friendly cultural cues from dearly beloved brothers and sisters, American brothers and sisters, we are ready to pull our morning’s fresh clothes out of the customary drawer in the bedroom in the house on the hill, and toss them at the end of the day, damp from the day’s humidity without and within, into their designated corner in that same bedroom. Our bedroom. Ours not by ownership but by use and custom. We’re ready to eat a little Weet-Bix (mixed with granola), to feel the surge of the six-cylinder diesel engine in the Patrol we’ve just been given by each of you, to hear the birds singing in the trees outside, to smell the smoke from the cooking fires, to hear the voices of the children from the orphanage, to see our friends.

Missionaries returning on furlough often long for something of home they couldn’t get “over there”. Dr. Pepper is a common object of such desire, and once going down it usually doesn’t taste as good as was imagined. We were deeply disappointed by the Starbucks we drank on landing at Washington Dulles. Now I look forward to a latte at the the Capucino Café in Lilongwe, and an expreso at the Italian Deli. I think that is a good sign.

Soon Harold will be unlocking the Hospital, Nelson will be arriving on his motorcycle, Napoleon may or may not be stopping by on his way to Saturday’s mission, but Salema or Berta will be opening the office. The workers at the plant will begin their weekly cleaning chores. But now it is 10:30 pm in Camp Chandler near Montgomery, Alabama, and I am being encouraged by the faith of brothers, and the words of my wife and my friend written for this occasion. Today, tomorrow and next week—if God wills--we will talk about our work and be encouraged by you and others, and then on Monday we will fly to Washington, then Addis Ababa, then Lilongwe: today’s home. And we will work to enjoy our new home, and prepare for the next, strangers and wanderers on this earth that we are.

"In Your Prime"

The “Hello’s” we exchanged came natural, both of us being “southern boys”. I’m not sure who spoke first. I was raised in Texas, and we spoke to everyone, and the late teen with whom I exchanged was surely Alabama born and raised, as his accent portrayed him. I was walking across the Walmart parking lot in east Montgomery to get the car. He was in the driver’s seat of the older model car, double-parked, probably waiting on his mom, his younger brother sitting in a back seat.

As I crossed in front of his hood he lowered the window on the passenger side and hollered at me: “Sir, you know where I can get some good weed?”

“Excuse me?” Maybe my hearing is slipping.

“Weed? You know. Marijuana? Do you know where I can get some good stuff?”

“I’m so sorry. I really don’t have a clue.”

“But ya do use don’t you? You do a little every now and then, no?”

“No, ‘fraid not.”

“But in your younger days you did, didn’t you? You know, back in your prime?”

“No, sorry, never smoked a joint. I can probably count on one hand the times I’ve had a beer or a glass of wine?”

“Really? Well, thank ya anyway.”

“You bet.”

Marijuana. I’m not sure who was more incredulous. Those who know me know I am a connector, constantly suggesting that this one meet that one, that the guy in this business might like to know this fellow I met over there. But where to get good weed? And, “back in your prime”? I’m learning a new language, still running 10K on weekends. Moses was 80 when he finally got his big assignment. I’m only 60. I don’t think I’ve hit my stride yet.

Then it hit me. The beard. The beard which is heavily streaked with gray. I’m having a little “re-entry cultural shock”, though. Cultural cues. Misunderstanding. Miscommunications. It happens not only in Malawi, but here in the Walmart parking lot in East Montgomery also. And I am older than I admit to myself. The joints ache a little more, a little more continuously. But the time to quit has not come, though it will. And until the Lord does offer a little R&R, rest and then renewal, a new body with new joints to do new work in a new environment, I’ll do what he has called me to do, with all my might, sharing the story of how to live the best kind of life possible on this earth until he comes or calls.

“In your prime!”