A makeshift clinic and a scorching sun: setting up in rural Malawi
I got off the small bus in the middle of a dirt road at the outskirts of a small rural village in Malawi, Africa. We had travelled several hours in the early morning hours to arrive at the next stop in a series of medical outreaches in the rural towns of Malawi.
Previously we had set up clinics in repurposed rooms in local orphanages. This time I did not see an orphanage, just some small crumbling brick buildings on the side of the road. Between the road and those ruinous buildings, a large open sided tent had been set up where the majority of the children and parents would be seen. We needed privacy since we would be screening women for cervical cancer.
The unexpected exam room: privacy in the ruins
The local coordinator signaled that I should follow him to where we would set up our makeshift clinic. He headed straight for the crumbling buildings and lead me into a room where at least the walls still rose above our heads. He said, “This will be great!”
I saw that they had already placed our exam tables and equipment containers in the small room. I looked up and saw a beautiful blue African sky. I looked down at the table and saw the sun shining directly on their black vinyl padding. I placed my hand on the pad and quickly realized that you could fry an egg on it.
I turned to the man, who was ready to move on to his next task and shook my head and said, “This will not do. We must have a roof. Can you get me a tarp or something?” He looked a little frustrated but mostly embarrassed and ran off to find something. He quickly returned with a long narrow tarp with plastic covered holes that were the sides of the large tent that they were not using because walls on the tent would make it way too hot.
The makeshift clinic in Malawi
Dr. Drew Moffitt’s treatment room in Malawi
The roof of the temporarily clinic
Problem-solving under the African sky
I had a discouraging thought as I looked at the four cement walls of our small exam room. I said, “This will be great!” and grabbed an old 2 x 4 and jumped up on the exam table, much to the astonishment of the locals in charge who were helping me problem solve. I put the makeshift pole under the tarp and began to position it over the walls of the room.
The tarp managed to cover half of the opening but as I tried to stretch it wider the walls crumbled a little and the coordinator, fearing that the walls would fall inward on us, yelled, “Stop!” Recognizing the wisdom of his command I jumped off the table and said, “Ok, let’s get to work!”
We arranged the room as best we could and I was happy to see that at least most of the surface of the two tables would be out of the sun and the sun would not be shining directly in the eyes of the women as they laid on the table.
Click to watch Dr. Moffitt tour the makeshift clinic he volunteered at in Malawi
Soon we were all ready to see our first patient. When she was positioned ready for the exam, I reached for the metal speculum and burnt my hand as I realized that they had been sitting in the middle of the room in direct sun and it was now scalding hot. I quickly ran and put my hand in water and then got a bucket of water to place the speculums in to cool them down before we used them. When I finished the exam on the first patient she softly said, “Thank you.”
The most profound “thank you” is a lesson in dignity
Her gratitude and the gratitude of the people that I served that day made a deep impression on me. These people had so little and were being seen under conditions that defy principles of human dignity – and yet they were grateful.
I was reminded of the first person I had to tell that they had cervical cancer. I am an infertility doctor so having to give that kind of news to someone is really out of my lane. She was a middle-aged woman with a kind face in another small village in Malawi. She must have seen the struggle and sadness in my eyes as I gave her the news because she kindly looked a me and said, “Its ok, at least now I know what I have. Thank you.”
I don’t know if she understood that in Malawi, that news is essentially a death sentence because they do not have access to the treatments that would at least give her a chance of survival and even if they did, she could not afford it. I did not have the heart to tell her but in her eyes, I could see that she probably knew.
What is it about certain people that gives them the capacity to have an attitude of gratitude? I am not sure, but I am sure of the result of having an attitude of gratitude. They are much happier than those who don’t. I know the elementary school stories of the first Thanksgiving and why they prepared the first Thanksgiving feast with the native Americans that helped them but why is Thanksgiving important for us? I am reminded of a song that we frequently sing in church around this time of year. The first verse goes like this:
“When upon life’s billows you are tempest tossed, When you are discouraged, thinking all is lost, Count your many blessings, name them one by one, And it will surprise you what the Lord hath done.”
Counting our blessings: focus on the walls, not the roof this Thanksgiving 2025
Rarely in real life is a day full of only good things or bad things. Usually, it is a mixture of good things and not so good things. The happiest people focus their attention on the good things. My local coordinator in that small village in Malawi, Africa, who said, “This will be great!” was focusing on the fact that he was able to get permission from the owner to use the dilapidated buildings so at least there were four walls so that the patients had some privacy. This Thanksgiving let’s take the time to not just focus on the lack of a roof like most of us do but that we have four walls. Doing that will make us happier and give us the inner strength build a roof.
Interested in supporting Dr. Moffitt’s work in Malawi?
Donate to the Butterfly Collaborative Cancer Screening Fund today.
A donation of $20 will screen one woman for cervical cancer.
Drew Moffitt, M.D., FACOG, is medical director and president at Arizona Reproductive Medicine Specialists Phoenix Fertility Clinics and an assistant professor at the University of Arizona.
He has been in practice for over 30 years and has significant clinical experience in assisted reproductive technologies and reproductive surgery. He shares stories with our patients about IVF and infertility treatment.
