First of all, mopane worms (aka the caterpillars I ate this past weekend) are disgusting. I remember an argument between two of my roommates in college, one claimed that her time in South Africa was a "culinary vacation" and the other came back and basically hadn't eaten anything in 2 weeks ... I’m going to have to side w/the latter (sorry Katie).

Second I think I'm the only person who can come all the way to Africa and still be cold on a regular basis. Somehow I forgot the seasons were reversed and winter is starting to roll in here ...

OK, now my week:

I've been at the PMH working in the Pediatric ward all this week. PMH is the government hospital which is adjacent to the Baylor clinic where I have been doing outpatient HIV care for the past 3 weeks. Baylor also supplies one of the three teams that admits and manages patients on the PMH pediatric wards. I'm afraid that I’m going to be utterly unable to capture for you what my week working in the hospital has been like. The "ward" is really just one big room that has been divided into 4 sections by 3 incomplete walls, there are no ‘rooms’. In each section there's up to 10-11 kids (plus family), some of whom have beds on frames, many of whom have mattresses laying on the floor. My first day we had 22 kids on our service (there are 4-5 people on our team, one attending, one medical officer, one intern, visiting scholars) and our list included one child with cryptococcal meningitis, one with H.flu meningitis, 3 with severe respiratory distress not responding to PCP, broad spectrum antibiotics, TB treatment or fungal treatment; Candida sepsis, post streptococcal glomerulonephritis complicated by PRES, kwashiorkor/marasmus ... and so on. We "order" things during morning rounds and then spend the rest of the day drawing our own labs (phlebotomy, catheters for urine and placing IVs - more or less), doing procedures (lots of LPs), placing catheters in anyone who needs it, making sure the nurses are actually giving meds when we've asked them to and running back and forth to Radiology because the machine to print x-rays has been broken since I got here. In the midst of all that, if someone crashes, then you also pause everything to resuscitate kids.

So those are the logistics (sorry for the excessive medicine shop talk). Personally this week has been, as I often find it, bittersweet. Full of both great joys mingled with heart wrenching sadness. We lost three kids this week - which is bad even by PMH standards. All babies between 3 – 6 months with respiratory distress who just ran out of energy to keep breathing. I'm not really sure how to tell you about this. But please pray for the mother's of Onka, Kim and Pride this week. Then there are also kids like Kaone, a beautiful one year old girl, who also came in looking like she was at deaths door, her mother didn't want us to do an LP but finally relented. Now she's been on crypto meningitis treatment for 10 days and is often the best part of my day as she wanders around the ward creating mischief. Gift, a 12 year old boy with post-strep ATN and PRES, laid deliriously in bed for 4 days not responding well to treatment … then woke up and started talking to us! We offered to get him some tea (he hasn't eaten in the last 4 days) and he says "God bless you very much" - he is slowing rejoining us.

This week I have discovered that there is a very quiet passage from life to death for those babies who go back to Jesus. But it is the pain of the mothers and aunts and uncles left behind that shakes us. However, it is also in these moments of profound pain that I see the beauty in humanity. I see complete strangers rally around one another in grief and support. I see mothers look after the kids who are orphans in the beds next to them, they give them food and play with them. They give what they have to offer no matter how large or small it maybe. They rise and sing Hallelujah to God every morning before rounds as a group.

This week I have also begun to see the Truth of why the poor and needy are the people of God - why those without resources are able to find Him so much more easily than I can. I used to think it was just because of simplicity - because they had so much less junk in their lives then I do. But this week I've begun to discover that maybe it's also because for me - I have the illusion of power. I have PICU's and ventilators and so many resources at my disposal to intervene and feel like I am exerting my power on the world - my will on life and death. But here, not because we have nothing, but because we are so near our own powerlessness, it becomes clear that I may treat and love and serve to the best of my ability as a doctor and a child of God - but ultimately, He is the giver and the taker of life. And as women on the ward laugh at my Setswana (that's their language) and look shocked that you hold doors for them and play with their children - the Lord reaffirms in my heart that every child I treat will go on to be sick again, to ultimately die someday in the near or far future. And although He calls us to fight for justice for His people, it is not the medicine and treatment I give that changes and impacts their life. It is the evidence of an unconditionally, unearned love that comes from Christ that mystifies, touches, changes people and brings hope.

I will spend my last week on the wards and fly next Friday. Hopefully I will send another update before then, but if not then I'll be sending the last email to you myself stateside.

Thank you all so much for your prayers and support - you have no idea how much they have meant to me.