The first thing I notice at the hospital entrance is a small plaque which reads 'Malamulo Adventist Hospital: We care, God heals'. Situated in the rural district of Thyolo, there are a small number of wards along with an outpatient department and a community clinic. Patients are mostly villagers reliant on subsistence farming or work for local tea plantations. Most were acute cases related to infectious diseases. I worked mostly in the general and paediatric wards, along with American doctors, Malawian clinical officers and nurses. working with limited resourcesIn a resource-limited setting, diagnosis and management is very different. Everyday bloods and imaging were not easily available, meaning that diagnosis relied on a good clinical history and examination. Malamulo has portable ultrasound, X-ray and two oxygen concentrators. Medications were limited, with staff driving two hours into the city of Blantyre to buy supplies from a pharmacy if stocks ran out. We regularly ran low on blood so doctors and nurses were encouraged to donate as often as possible. There was neither hand sanitiser nor adequate personal protective equipment.
The most difficult cases for me were those that highlighted the disparity in health outcomes between rich and poor. Children born with HIV/AIDS endure a life-limiting consequence through no fault of their own. A 31-year-old female presented with renal failure from drug-induced nephrotoxicity — a common side effect of her HIV medications. In the UK, she would have been a candidate for dialysis or even transplant. But there are two dialysis machines for the whole of southern Malawi, for which there is a long waiting list and a formal application process. Though she was young, she was deemed unsuitable and rejected from the list. All we could offer her was palliative care. She died three days later. None of the good work at Malamulo would happen without faith. The handful of American doctors, surgeons and their families who reside there permanently, are employed by the Adventist Church on five year contracts. The level of dedication and compassion I have been able to witness in each of them was beyond inspiring. Their unconquerable determination in the face of immense limitations is what enables Malamulo to deliver.
On the outside I tend not to display emotion. But every day, I was internally brought to my knees and humbled. I felt a strange mix of emotions that I can only describe to be a feeling of submission, recognising how fragile we are, mixed with a sudden euphoria that I could not quite place. I felt every day I was living with this joy. For the first time in my life, I felt I could say that I had a purpose and that I would not want to be anywhere else in this moment. I had never felt like this about anything before in my life. taking up the cross I thought I had my priorities straight. I have never desired a life of luxury or wealth growing up and I worked hard so that I could one day make the world a better place. I wanted a 'normal' life that partakes in modern society and also served God. In my mind, my goal had been to do God's work and live a not wealthy but not poor life. I had assumed that good things I wanted to achieve in life went hand in hand with what God wanted. But God seemed to be asking me a deeply uncomfortable question — was I was truly living for Christ or myself?
I felt an interrogation that I could not avoid, that would not leave me in peace throughout my days in Malawi: if it were asked of me, could I give up everything I had ever desired and choose to suffer with Christ? Would I be ready to give up the life I had dreamed of living and take up the cross? Would I be ready to be perceived as a failure by everyone I once knew if that is what is asked of me?
The Bible is clear that to truly live for Christ, a person must deny himself and be willing to take up the cross.  He must deny all he once held dear. The story of the rich man in Matthew 19 highlights the sheer difficulty of what is asked of Christians.  The path that Christ asks us to take is composed of suffering and sorrow; it requires immense sacrifices and being ready to be hated by the world. 
I met some of the happiest people I have ever come across while in Malawi. They lived humble lives, yet seemed to experience unconditional joy. It was as if every day the world smiled on them and they smiled back. I wondered if the root of dissatisfaction in UK society is in our constant yearning for happiness that is conditional on various goals being met. Had I, perhaps, got it wrong this whole time? Maybe it is that the joy that these people feel, and the joy that I am slowly beginning to feel, is in submission to God's plan and letting go of my own desires, no matter how noble or righteous those desires may have seemed. It reminded me of the meaning behind the words of an 18th century English hymn: My richest gains I count but loss, and pour contempt on all my pride… All the vain things that charmed me most, I sacrifice them to his blood. I do not know why it felt like such a pressing burden on my conscience. I wondered if maybe this was the voice of God teaching me to surrender and instead, to willingly follow a path I may not have wanted. To live more for Christ and less for myself. The kingdom of God is not a physical place, but it is wherever God rules. It may just have been in a crowded hut in Thyolo, where a few Malawian villagers share their nsima bread and praise God with songs for what he has done. And they were the ones who showed me what true joy looks like. ?