fire on the mountain

fire on the mountain, originally uploaded by mattcotham.

When I was a kid we accidentally burned down the neighbors yard by
putting some not-quite-extinguished coals in a bag of grass clippings.
I think I'm getting a little payback this week. It's a little late for
the burning season here -- it's usually in June-July -- but the last few
days we've had a couple of fires creep pretty close to the hospital.
This is the hill next to the hospital, and then the next day the field
behind my house was set on fire and burned to about 50 yards of my back
door. It makes me a little bit nervous when you realize there's no fire
department for about a 4 hour drive. But everything did fine, and
actually now I'm pretty safe since there's nothing left to burn....

jewish zambia

We are cranking out the circumcisions these days at the hospital. Who
would have thought that adult circumcision would be such a popular
thing, especially since we aren't doing childrens' circumcisions very
much. There's a big push in the country because circumcision is thought
to decrease the HIV and sexually transmitted infection rates, so there's
funding to get these done. I honestly don't really understand the
popularity amongst the local populace, but we get lines of 10-15 young
men every Saturday outside of the OR to get the snipping done. Many of
our hospital staff has signed up at one point or another. Fortunately
I'm involved very peripherally -- only to give a few words of comfort as
they gingerly make their way around the hospital on Monday morning.
I won't put any pictures with this post. :)

Leaving home

Hello again from Mukinge!

Time in Zambia is rapidly drawing short for me -- my departure date has officially been set for November 10th, which is just 10 weeks away from today as I write this.  I had my end-of-term review this week with the director of the mission, which seemed maybe a little premature -- what if I set the hospital on fire next week? -- but has given me a chance to do some reflecting and thinking about what I've been learning over the last two years:

- community: except in a family, there's not many communities like a mission community, where you work, socialize, exercise, eat with, go to church, and in general never escape a small group of people from widely different backgrounds (Ireland, NZ, China, England, America, Canada, Zambia) and ages (2 weeks to >70 years old).   Psalm 133 -- 'How wonderful, how beautiful, when brothers and sisters get along! -- expresses the idea that a vibrant community is one where every day brings a sense of expectancy to see what is being done in each others' lives and in your own.  I've been growing in learning about forgiveness and refusing to 'close the door' on a relationship because of past issues or hurts; God's mercy is new every morning and I cannot deny the possibility that each day brings a transformation in each of our lives.  (Read C.S. Lewis' "The Weight of Glory" for a more erudite exposition of that theme.)  It's been a good journey to learn to live with that sense of possibility.

- transformative development: entire books, thesis, and international organizations have been dedicated to figuring out how to best help people in Africa.  It seems to me that Africa itself has had more difficulties showing progress than other nations in the developing world, especially in the areas of poverty and disease.  I've been struggling with these concepts as we've been working with the nutrition project, to try to bring some small amount of transformation in the farming practices in a way that doesn't foster dependence, shows the love of God for the people, and will make a change in the area.  I've been learning from lots of different sources and experiences.  One conclusion that I have come to, however, is the one that our western ideals of independence and self-sufficiency are neither biblical or practical for the region.  We should be aiming for interdependence, where all of our gifts on both sides of the coin are freely offered and control is relinquished to achieve the greater purposes for the area.  Of course, for true interdependence, each gift has to be honored, even the gifts that don't seem so important from a western perspective.

- hope: for many people, hope is at best a vague longing, a feeling in the pit of your stomach that things could be better, a dissatisfaction with the state of the world.  Here I've been in touch with a more concrete definition of hope, however, that not only recognizes the dissatisfaction but also knows that a remedy is coming.  Every day has the potential to be a depressing day in the hospital -- small kids with cancer, HIV and its consequences on individuals and families, neglect and malnutrition, inadequate health care being offered by referring institutions and by the hospital itself, witchcraft and shamanism, and death and disability in all of the patients at the hospital.  Learning to have hope in a setting like this one has been difficult, but life-changing.

There's still a number of things going on in my last few months -- organizing 16,000kg of seeds to distribute to the surrounding communities, getting anesthesia machines and soft-serve ice cream installed at the restaurant that we built this year, working on a survey research project for children taking HIV medications, organizing a training for community malaria health-care workers, and of course just being a doctor in the hospital with all its usual challenges and joys.  I have been so appreciative and blessed by your support and prayers over the past two years.  I've mentioned it in previous emails but you have been so generous with money and time for the work here in Zambia.  I think it's been a real picture of interdependence in my life to be here.

Thanks so much for all of you.  I will be back in Fort Worth after Nov 19th and through the holidays, and then likely back to Denver sometime at the beginning of 2009 to start up work again (this is still in the air, so if you've got some job tips, I'm all ears!).  I hope to have a chance to share with each of you what these last few years have been like and where I'm heading next.

All the best,
Matt