Spring 2017 Writing Roundup

We are now traveling around East Africa in search of a new hospital to work at since Yei seems like it will remain closed to families for the immediate future. We’ll have a big post with all of the places we visited in a few weeks, but here’s what I’ve been writing and recording lately:

Creating a Just and Good Healthcare System– I was invited by the Maryland Chapter of the American Solidarity Party to give a talk about healthcare. Watch Mere Orthodoxy for the full text of the talk, coming soon!

Dorothy’s Place Podcast, Episode #1– The good folks at Solidarity Hall are trying to figure out how to live in community in light of the technological and economic changes that try to push us apart. They invited me to be on their podcast and we had a delightful conversation about healthcare systems in America, South Sudan, and Japan:

In Alien: Covenant, the March of Progress Ends in Death– The first two Alien movies are some of my favorite films, so I was eager to see what Ridley Scott would do with Alien: Covenant. I enjoyed the movie, but I also found a lot of themes relevant to technological ambition, our cultural infatuation with Science! and medical ethics.  As one of my friends likes to say, “The gods of our age are death and fruitless sex.” Alien: Covenant is about the endgame of those gods.

Dangerous Territory Feature Review– My friend Amy Peterson recently released her first book, Dangerous Territory. It’s part memoir, part examination of contemporary missions issues, and really worth reading overall. Maggie also really enjoyed it, if you’re wondering!

The Insanity of Autonomy- This is a post on my Mere-O sub-blog that further developed my thoughts in a Christianity Today article about a new Gallup poll about morality. I talk about how there’s no way to “win” any culture wars if our culture sacralizes autonomy — especially if our other political commitments reinforce this!

The Christ and Pop Culture 25: Nintendo Switch, S-Town, and Silence– I was back on the Christ and Pop Culture podcast talking about the most important things in pop culture this year. Naturally, I won by defending the film Silence, although quite frankly we kind of knew Silence had to win from the get-go and my co-hosts did an admirable job fighting a battle they knew they were going to lose.

What Political Theology are You?– Yes, I helped make a web quiz. Yes, it was fun. Yes, the results are for entertainment purposes only. Yes, you are probably a Liberal Protestant.


What have we been up to?

Many of you following along with us know that we are heading back to East Africa in June. This has been a season of in-between for us, with featuring stages like: recovering from being evacuated, getting into a routine, waiting to have a baby, having said baby, then preparing to return. Now we are in the throes of planning to see people one-last-time (so much grief!) and packing (slightly easier when you’ve launched a family over the ocean once, by God’s grace!). I thought I’d share a little bit of what our time here has looked like…

1. Henry. We had that baby. Gosh he is the sweetest thing. Here, I’ll show you:IMG_8558

For real…


2. Family and Friends. We were so grateful and blessed to be welcomed back into the fold with our family and friends, who let us back in, or came and visited from far away (sometimes multiple times). We were home for Thanksgiving, Christmas, Easter, and a wedding. Obviously, this is the best thing about being home. We have the best people in our life and I am so grateful for them.


3. Work and School. Matthew had the opportunity to complete 9 credits at St. Mary’s Seminary Ecumenical Institute and really enjoyed it. He also worked as part-time faculty at his old residency at Franklin Square, doing some clinic, inpatient, nursery, and OB. It was a good mix for him. I completed a couple of bible credits through BSF this year studying the Gospel of John, and 3 credits towards my BSN.


4. Books. SO MANY BOOKS.

Many people have asked about what we’re doing for Naomi’s school this year and the answer is, mostly, a lot of reading. This is how I have felt about being near public libraries again.

Winter 2017 Writing Roundup

I have been busier lately at my sub-blog at Mere Orthodoxy, including a post about 5 different options for fixing American healthcare (including blowing it up!)  As we prepare to return to East Africa, we hope have more to write here! In the meantime, here’s what I’ve been writing lately:


In Violence We Trust?– People often talk about “senseless” violence, but violence makes a lot of sense for people who feel insecure. I explored the relationship between violence, trust, and security and how we can use these ideas to reckon with the problem of inner-city violence in America.

Green Card Holders in the City of Man–  With refugee resettlement and immigration in the news, the Bible is being deployed frequently in our debates (but not always thoughtfully). I wrote about how we might get beyond prooftexting in wrestling with the challenges these issues present to God’s people and their place in the modern nation-state — as well as the world that the Bible anticipates.

“The poor will always be with us” is no reason to cut Medicaid– Congressman Roger Marshall recently applied some… interesting exegesis of Jesus’ words about poverty and Medicaid. I gave a brief response for America magazine about the challenges poor people face in obtaining preventive care and what it will really take to care for all of our bodies.

Living and Dying Well: A Vernacular Podcast– Zac and Sally Crippen invited me to be on their podcast (which is well worth listening to if you enjoy stimulating conversations). We had a great talk about death across cultures, dying well, and a richer understanding of bioethics in medical education.

Making Amends: Eve Tushnet on Addiction in Our Time– Eve Tushnet’s novel “Amends” is the funniest book I have ever read, and it is also moving and beautiful and just go buy it already, k?

Black Mirror, Technology, and the Darkness of Our Hearts– The Christ and Pop Culture Digest had me back to talk about my article about Black Mirror and technology’s power to amplify our sinfulness. We had a great chat!

A Social Justice Warrior in King Roderick’s Court– I have really enjoyed becoming familiar with the work of Plough Magazine and couldn’t miss the opportunity to join them when they hosted Rod Dreher in New York at an event about the Benedict Option. They also pulled together a great panel to respond to Rod, so I explored some of their excellent responses.

Civics is not LARPing– This was supposed to be a sub-blog piece, but I accidentally published it on the Mere Orthodoxy main site. Whoops! I’m glad it was one of the better ones: trying to figure out how to increase civic engagement and cultivate virtue in our peculiar political environment.

Go To Church LOL: An Impertinent Catechism– Everything you ever wanted to know about why Christians and the Church are so awful and why you should go to church even if it’s full of bigots.

Comfort Detox: Free for CaPC Members– Once you know that the stuff you’ve always wanted and the comfort you’ve always worked for isn’t enough, what next? Erin Straza’s book “Comfort Detox” explores this question, so I wrote about it for CaPC (it’s free with a $5-a-month CaPC membership!)

Summer/Fall 2016 Writing Roundup

Been a while since I posted a writing roundup– the craziness of our transition and other things going on kept me from writing at my normal pace, but things are picking up and I have some more big pieces in store for early 2017.

Is Addiction a Disease? Yes, and Much More– My final scheduled contribution for Christianity Today got upgraded from a column to an essay, complementing the cover story on opioid painkiller addiction. There’s often a simplistic binary between viewing addiction as “a disease, just like diabetes” versus a moral failing. I think the biological aspects of addiction are fascinating and help illuminate our understanding of the moral & spiritual aspects of the disease– as well as point us to how we can work together to stop it. I also got to talk about Suboxone and methadone in a Christian publication, which is pretty cool.

The Babadook: Sometimes, Self-Care Just Isn’t Strong Enough– We went through a lot in South Sudan. It doesn’t really compare to the suffering that our East African friends and colleagues went through, but it was enough to shake us. When Maggie got evacuated with the kids to Uganda, I watched The Babadook and found it a very compelling reflection on grief and the scars we bear.

9 Ways to Share the Cost of Cultural Engagement Now That Books & Culture is Gone– Books and Culture was a great magazine, and I’m sad to see it go. So much of our current crisis of discourse relates to the fact that great magazines and compelling, thoughtful discussion just isn’t supported and read widely enough. I provided some suggestions for people who want a better discussion about culture.

There’s Nothing New Under the Black Mirror– On a similar note, I used Black Mirror to talk about how technology and social media dehumanize us– and a few more suggestions for publications that might help us think and talk differently.

Do We Really Need More Breast Cancer ‘Awareness’?– I wrote this column for Breast Cancer Awareness Month in October. There’s an overemphasis on awareness in our discussions of health, where I think the concept of attention is far more useful to consider. We don’t need more information about disease (or our sin, for that matter)– we need to attend to our bodies’ needs and discipline ourselves to care for them.

When the Neighborhood Changes– We’re inclined to think of “gentrification” as a dirty word, but everyone wants their neighborhood to get better. How to do so is a bit more complicated. I focused on how we can focus on building and reinforcing neighborhood institutions so that gentrification empowers residents rather than displacing them.

Member Offering: Os Guinness’ Impossible People– When you join Christ and Pop Culture, you get free ebooks and albums every month in addition to access to the Members-Only Facebook group, which is a real breath of fresh air in the social media morass. It’s a great deal! I wrote the blurb for one of these giveaways, Os Guinness’ book Impossible People.

A Pro Life Third Party: The American Solidarity Party– Our agonizing election is over now, but now is a great time to join the American Solidarity Party and call for a holistic pro-life approach to politics.

A Trump Presidency Would Hurt the Pro-Life Cause More Than Hillary– Another election-related piece, all I’ll say about this one is: I hope I was wrong.


Vision, passion, commitment, & calling

As most of you know, our family was evacuated from South Sudan a few weeks ago because of security concerns. We’d spent 9 months slowly acclimatizing to life there: learning how to live in a very different environment, practice in a very different hospital setting, and minister in a very different culture. Our language skills had progressed to the point where I could converse with most patients in the hospital about their routine complaints and we were excited to start planning for some new ventures to meet patient needs.

And then we had to leave.

If you’ve heard us talk or followed my writing for any length of time, you know that I’m a pretty vision-driven person. Maggie is more of a “details” person (thank God), but we wouldn’t have gotten married or done half the things we’ve done if she wasn’t also animated by a strong sense of purpose and calling. We were led first to Sandtown and then to South Sudan by this sense of calling, making a lot of sacrifices and taking a lot of risks along the way.

I don’t want to overemphasize what we’ve suffered because it pales in comparison to many others that we know and love, but it is hard to leave behind friends, family, and a very comfortable income to move to a place where cobras crawl up on your front porch and armed men randomly attack innocent people. It takes a certain degree of vision and passion to overcome the inertia that would otherwise keep us in a more comfortable place and to sever or strain our connections with people and places that we had come to love. Without a sense that what we are doing truly matters in an eternal and transcendent way, it is nearly impossible to conceive of making the sacrifices we made, much less put in the years of preparation we did to accomplish them.

We learned quickly once we got there that vision and passion have limits. We were about as well-prepared as we could be (in no small part thanks to the people who had come before us and faced certain challenges we never had to face), but it was still very difficult and we had a lot of our own unique challenges to deal with. In particular, I was finding that the vision and passion for medical education and discipleship were necessary to get us to South Sudan but wouldn’t provide the same animating force for my day-to-day life once I was in the field.

The routine disappointments of cross-cultural miscommunication, the personal flaws that were only magnified in our setting, and the more jarring traumas of death that are simply realities of life in a mission hospital were never going to fit in a presentation like the ones we gave dozens of times as we raised funds to go. I’d spent over ten years preparing for this life, but actually living it was still a steep learning curve. A vision like “training and discipling health care workers in a place where thousands die of preventable causes” was a great thing to aspire to, but a very difficult standard to judge myself by every day.

The spiritual friction this struggle created had to be eased somehow, so I found myself withdrawing into books, games, and social media. I don’t think any of those things are necessarily bad in moderation (especially in our case, where social media helped us stay connected with people we loved back home), but I was not good at moderating. I never neglected my work or my family, but I was missing out on a lot of opportunities to love and be loved—which, of course, only made me feel worse and emphasized the discrepancy I felt between how I spent my time and the vision that I’d cast for myself over all those years.

I discovered that I was the same terrible person in need of Jesus that I was back home, and it was good for me to wrestle through some of the struggles that I had put off up until this point. (I suppose I had expected that my problems would somehow improve on their own after moving overseas- ha!) After some counseling and good conversations, I began to work out some practices and disciplines that would make me content with how I used my time and not drive my wife crazy.

It became difficult to maintain any regular practices or disciplines when things started to fall apart around us, especially when we decided in July to send Maggie and the kids to Uganda for a few weeks. Simultaneously, the push of our vision and passion ebbed simply because the needs of the community and the capacity of the hospital changed as the situation became more dire. We were no longer attempting to build a better health system by training African health care professionals; we were trying to keep a hospital open in a place where the basic institutions of civil society were falling apart. We often discuss the difference between “relief” and “development” work—we were moving from the latter to the former very quickly.

In this rapidly changing work environment, my grand aspirations had to take a backseat to simple faithfulness. Someone that I was trying to minister to could be forced to flee tomorrow; the hospital could close overnight. I had to ask myself, “how should I be faithful to what God has called me to today?” That was a lot easier than judging myself for not living up to everything that a decade’s worth of vision and passion were driving me towards.

Now I am forced to ask that same question, but with a very different answer. On August 30, 2016, being faithful to what God had called me to meant taking my small children out of a place where the risk to their life could no longer be ascertained with any certainty. The potential good we could do (the population we served at the hospital fled in huge numbers) was diminishing while the potential harm that could come to us at any time was rising. On every day since then, faithfulness has been a matter of waiting and praying while going through the necessary steps to remain here in America for the next several months while we wait for our baby to be born.

We don’t know what’s next. We hope and pray that we can return to South Sudan in Spring 2017 and if we can’t, we’ll find another place where a doctor and a nurse can serve by training and discipling health workers. Until then we’ll have to figure out how to be faithful servants where we are.

Vision and passion are great things, but without faithfulness they are ethereal (at best) or harmful (at worst). I look forward to living in a place and doing work that lets me pursue our family’s vision and live out my various passions, but right now that simply isn’t where God has led us. While the hurting places of the world require more people with vision and passion to go to them, what every place needs is people who are willing to be faithful where they are.

Scenes from everyday life

The last month has included an evacuation and a visit from family. It has not exactly been normal, but there have been some really good moments in between stressful times. IMG_6779

Relaxing with Samuel and eating some sugarcane


Green beans! — count as a luxury here and Naomi’s face says it all!


Orange and pink flowers in the front yard– inside is a nice bed of mixed lettuce. Another food luxury!



the flock enjoying a nice pumpkin


at the top of Murchison Falls with Aunt Keller


visiting the nurses. Susan put on an ABC video– can you tell which two are siblings?


Enjoying the climbing frame in Arua with friends


young lions on safari


cheeky monkey enjoying the splash pool


scouting for giraffes on top of the safari van with Aunt Keller


enjoying medida (millet morridge) with Evans



One intense face to close things out…

Spring 2016 Writing Roundup

Lots of references to Viagra in these pieces!

Health is About Way More Than Weight– My latest Christianity Today column is about how the Church can deal with the obesity crisis– by focusing less on the actual numbers and more on ameliorating the problems that cause us to overeat or smoke in the first place.

Strength in Weakness– I really liked Andy Crouch’s new book, Strong and Weak. Though I still think his last book, Playing God, needs to be read by more people!

Our Drugs Addiction– This CT column from May takes on the pharmaceutical industry’s preferential treatment of the rich. and what anyone can do at their doctor’s office to help push the system in a better direction.

How Then Shall We Work? Medicine– I participated in the Comment symposium on technology and the professions, focusing on medicine. I discussed how electronic medical records demonstrate the foibles of using technology to make things better. I still wish we had been able to use the original title, “User Error” but it didn’t quite work in the print layout.

What West Baltimore Needs– The American Conservative wanted a retrospective look at the events in Baltimore last year, so I wrote about how the immediate response to the unrest was a picture of our disorganized and dysfunctional approach to helping struggling urban neighborhoods. I also pointed towards some of the ways that we could do better as I explored the costs of dealing with the culture that helps poverty stay entrenched.

Benedict and Jesus– If you’re not tired of the Benedict Option discussion, I jumped in again to go back and forth with Alan Jacobs (who ended up replying here).

Sewing and Shame

Honor and shame dominate many cultural interactions here. High-status positions within medicine bring honor and occasionally a sense of entitlement. Correcting anyone in front of other people is felt to be shameful, which makes the back-and-forth of medical education quite difficult. In my residency training, the best teachers were the ones who interrogated my diagnoses and treatment plans until they had found holes in my reasoning, pointed them out for everyone to see, and challenged me about how to think differently about clinical problems. Even changing previously written orders while on rounds together can bring shame to the clinician who wrote the now-abrogated order. (To be fair, my experiences in the American medical system had plenty of hurt feelings over honor and shame!)

Our challenge is to work within the existing culture and recognize its strengths (America is learning what can happen when you keep saying “anyone can be President!”) while encouraging people to take on Christlike humility. It is not easy to be humble in any culture, but it’s particularly challenging in a place where saving face is more important than getting things done and throwing one’s weight around is often the only recourse for maintaining a high standard of care for our patients.

I wasn’t really thinking about this at 4AM on a Sunday morning when poor Graham got roused from sleep to come help me with a surgery, but he was.

I had already been awake for two hours, trying to get the c-section done quickly enough to go back to bed before church. It seemed fairly routine, though I was having trouble controlling the bleeding after I got the baby out and I didn’t know why. I’ve now been doing c-sections on my own routinely, trading off cutting and sewing with some of our clinical officers so that they can grow in experience, too. I hadn’t called for help from one of the more experienced doctors in over a month, but after I had already done all I could do, I felt like I had no other choice but to call for assistance.

One of the great strengths that both expatriate doctors who have both been here for years share is their sense of calm in life-and-death situations. (Read more about Jeff here and Graham here.) It was no different this early Sunday morning as I held pressure and Graham ambled into the operating theatre, putting on a mask and leaning over to look into my surgical field as I threw my hands up in exasperated fear that I had done something wrong.

In a manner meant as much for the staff gathered in the room as for me, he mentioned a time when he had made a mistake at the step in the operation I was stuck at. After a few minutes of looking around, I realized that I had followed in Graham’s footsteps and made exactly the same mistake!

This was my first time that I’d had to cut my own sutures in the middle of an operation. It was not a pleasant experience to undo my very thorough (and very wrong) work, then keep the rest of the surgical team up for an extra half hour while I fixed my mistake. The patient and her baby did fine, but I was of course ashamed and discouraged because I’d made such an ugly mistake.


When I got home, Graham had already written me an email. It was a perfect example, he suggested, of how peers correct each other and accept correction while maintaining mutual respect. While I would personally like to have opportunities to be a light and a witness in ways other than “models humility when wrong”, I was really thankful that we were able to have that interaction as an demonstrate something that the long-term workers have been talking about for years.

Every medical team, no matter where they are practicing, will make mistakes. And no matter where you are, the people involved will feel the urge to save face and resist correction instead of being honest and working together to find a solution. We need good systems and protocols in place to catch mistake before they cause harm, but we also need humble-hearted clinicians to take responsibility and change course, even if it might mean admitting you were wrong in a culture where doing so brings shame. I don’t know when my next opportunity to learn something the hard way will come (hopefully at a more reasonable time of day), but I’ll certainly look at it as an opportunity to teach, too.

The gift of a safe delivery

As Dinya, the clinical officer, prayed, I quickly pushed the ketamine into the patient’s IV. I watched her carefully; she was struggling to relax.  After thirty seconds or so her face began to relax. Dinya began pinching folds of skin on her abdomen, while I watched her body language for tension, to ensure she was numb enough to begin the c-section.



Five months in, it was my first time running anesthesia for a c-section independently. Since we’ve moved here, I have been working at the hospital on Thursdays. Matthew stays home with the kids and I am grateful for a husband that’s willing to jobshare a bit so I can be part of the action. It is true, though, that coming in only once a week has made for a slow onramp to feeling anywhere close to confident. Anesthesia in particular feels like something a nurse should have, oh, at least an additional Master’s degree in.

My preceptor, Kitty, poked her head into the OR. “You ok?” she asked. But I was; I was feeling like I could anticipate solving several problems independently before I’d call her for backup. It had helped that we’d been together with some difficult cases. “All right. Let me know if you need me.”

I turned back to the patient, and I watched the monitor as her oxygen level promptly dropped from 100… to 96… to 92… to 87. Right. I propped her jaw forward to open her airway further. Nothing. Time for oxygen. I watched her oxygen saturation rise again, and offered a quick prayer of thanks.

It was clear even a few minutes in that she was metabolizing the ketamine quickly. She began to grimace a little, to sing a little. I watched her carefully and prayed; sometimes ketamine just makes you talk. It can also cause uterine tension and make baby a little slow to start breathing. I really didn’t want to have to give her any more if I didn’t have to.

The blood pressure machine was broken, so I assigned a midwife student to take the patient’s blood pressure every few minutes manually for me. I also decided she needed a little more ketamine, explaining to the visiting doula who was shadowing why I was hesitant to do so.

A few minutes after that, Lo and Dinya pulled a 3-kg baby out. The cord was wrapped around the baby’s neck three times. “Right,” Lo said matter-of-factly in her Irish accent,. “this one definitely wasn’t coming out normally.”

In America, having a c-section can be a mark of shame for a woman. My first child was delivered via cesarean; when the doctor announced that, at the eleventh hour, Naomi had flipped into breech position, and with my water already broken, a c-section was our only option, quiet tears rolled down my face. I remember talking a friend through feelings of disappointment that she wasn’t able to deliver her baby vaginally, receiving positive e-mails from a VBAC (vaginal birth after cesarean) support group listing tips for talking to your doctor, reading in a childbirth book about ways to delay c-sections, and trying to drum up as many suggestions as possible for convincing your doctor to give you more time to do it yourself, as it were. To be fair, there are reasons why c-sections are not preferable to vaginal births. I pursued a VBAC with our second child, and was glad for the easier recovery. But as the baby’s cries rang in the air, indicating health and liveliness, I was reminded, again, that having a c-section available to me, done by competent health care professionals was, and is a gift.

It was a gift that multiple competent doctors were ready at that hour of the morning when we went into the OR for Naomi’s delivery. It was a gift when Dave, the scrub tech, walked into the OR and cussed audibly because I was sitting on the table getting my spinal block put in. It was a gift when Rose, labor and delivery warhorse that she is, kept a close eye on my heartrate when it dropped into the 40s after surgery. And my anesthesiologist, Tom, was definitely a gift, as he explained to me what was going on behind the curtain– despite the fact that I had been in c-sections as baby nurse before, being the patient was a little scary for me. He walked me through it with a caring manner and kept me pain-free.

I took the bucket containing the placenta and blood out to the pit behind the incinerator. Emerging from the OR into the sunshine was a breath of fresh air. I made a mental note to bleach my shoes the next day. What a gift.



Malaria, Typhoid, or Both?

All four of us have had malaria now– mild cases for everyone, fortunately, but I can assure you that it’s no fun. It’s particularly vexing for our family because we use an awful lot of precious Nutella and jam to get the kids to take their awful-tasting Mefloquine every week, and we aren’t the only family taking prophylaxis faithfully to get malaria this year– several other folks here on campus who take medications ostensibly to prevent us from ever getting it have had to settle for “at least we didn’t need to be admitted for it”.

Sadly, children in the community without the luxury of living right next to the hospital or taking prophylaxis haven’t been as fortunate. The rains seemed to have started a little earlier this year, and whether the parasite itself is getting more virulent or the mosquitoes are biting more, we are seeing more cases requiring transfusions and deaths several times a week in young children.

With very little data to work with besides our own overflowing wards (and similar stories from other clinics and hospital all over town), we can only conclude that transmission of the parasite is more frequent and the best we can do is test as early as possible and treat as quickly as possible.

Fortunately, malaria is one of the few diagnoses we can reliably make in the hospital because you can see it on a blood smear. The lab tests we can order all fit nicely on a half-sheet of paper, and half of these we rarely order anyway:


However, malaria shares a number of clinical features with typhoid– both cause fevers, headache, dizziness, abdominal pains, vomiting, joint and muscle aches. The main differences when taking a history are that typhoid tends to cause constipation while malaria can sometimes cause more diarrhea and malaria tends to be much faster in onset– but that’s about it, at least in the first week of illness.

You can order labs for typhoid, though– the Widal test, an old serologic test that measures antibodies to the Salmonella typhi bacteria. Unfortunately, this test can’t distinguish between current infection, previous infection, or successful immunization, so in a population where typhoid is quite common there are quite a few false positives. This hasn’t seemed to slow down the test’s popularity, as it is still used quite a bit because it is cheap and quick.

When discussing patients with our clinical officers and nurses, we often have to remind them of this false-positive problem and ask if there are really enough clinical symptoms present to convincingly make a diagnosis of malaria and typhoid. Many of our patients are sick enough to justify using antibiotics to cover typhoid in addition to antiparasitic drugs for malaria, but many aren’t. We certainly don’t want to expose our patients to potential side effects or create antibiotic resistance in an area where few drugs are available. We also don’t want to waste precious resources since the drugs we do get are imported and patients pay more for each drug we order! Thus, in the midst of our current wet season with malaria popping up everywhere and causing more severe cases than usual, I prefer not to even use the Widal test unless I have a really good story that makes me think my patient has typhoid instead. (And even then, I’ll still check for malaria anyway.)

So I when started feeling achy and fatigued, I of course dilly-dallied for a day or two before finally getting tested– and I didn’t bother ordered a Widal, since I was vaccinated. My smear came back positive and I started on treatment. I was especially thankful that we had several other doctors at the hospital who could take over while I was sick– when we came for our survey trip, there were only two doctors working full-time and when one of them got sick or went on vacation, managing 40-50 patients a day was just up to one person!

I finished my three days of medication and woke up in the middle of the night, unable to go back to sleep because it hurt to roll over. I took ibuprofen and paracetamol but still felt awful and got caught up on a lot of podcasts as I gained a new appreciation for why the pediatric ward was always full of shrieking children. I spoke to our wise medical director, Graham, who recommended that with persistent symptoms, I should probably just start treatment for typhoid.

After a day of mostly sleeping and taking Amoxicillin, I felt great. I got up, jumped right back in on the wards, and didn’t take another dose of pain meds. I still don’t know if my symptoms were caused by typhoid, malaria, both, or neither– perhaps I had a virus that got better at the same time I started taking the antibiotic and just happened to have a positive malaria smear– but who knows? Here, we just have to do the best we can with what we have and continue to train enough medical professionals to assess and treat people with malaria quickly enough that they don’t require transfusions or get sick enough to die.

I still don’t order the Widal, though. And I’m trying to teach our staff to be more judicious with it, too!