Chapter 1 - The Journey
Dr. Emily Harper looked out the small oval window of the airplane and smiled at the patchwork of fields disappearing beneath the clouds.
Even from thirty thousand feet, Indiana looked organized.
Square fields stretched toward the horizon, divided by narrow county roads and dotted with farmhouses, grain silos, church steeples, and the occasional stand of trees that had somehow escaped being turned into farmland.
People called places like Indiana flyover country.
Emily had never understood that expression.
To her, Indiana was home.
She had traveled to New York and California, Florida and Maine, Arizona and Oregon, and enough states in between that she had long ago stopped collecting refrigerator magnets from them. She had seen mountains that seemed to touch the sky and oceans that made her feel impossibly small. She had walked crowded city streets where thousands of people could pass within inches of one another without ever making eye contact.
And yet she always came back home to Indiana.
There was something about the people there. They were unassuming. Friendly without being intrusive. The kind of people who waved when you passed them on a country road and stopped to help change a tire even if they were already late for work.
They didn’t make a production out of being good people.
They simply were.
Emily rested her forehead against the cool glass.
I’m going to miss this.
The thought surprised her.
She was thirty-two years old, not eighteen. She wasn’t leaving for college or moving across the country. She would be gone one month.
Four weeks.
She had been looking forward to the trip for nearly a year.
Still, as the green and brown squares disappeared beneath a layer of clouds, she felt something unexpected tightening in her chest.
Maybe it was her mother’s fault.
“Four weeks is a long time.”
“Mom.”
“I’m only saying.”
“And you’ve been saying it for three months.”
Emily’s mother stood beside her at the airport, holding her daughter’s arm as if Emily might somehow be swept through security before she had finished worrying.
Margaret Harper had worried professionally for most of Emily’s life.
Was she eating enough?
Was she sleeping enough?
Was she working too much?
Was her car making that sound again?
Did she really need to live twenty-five minutes away when there was a perfectly good house with an empty bedroom right here?
Africa had simply provided Margaret with an entirely new category of things to worry about.
“You have your passport?”
Emily patted the front pocket of her carry-on.
“Passport.”
“Money?”
“Yes.”
“Credit card?”
“Yes.”
“Copies of your passport?”
“In three different places, exactly like you told me.”
“Medicine?”
“Mom, I’m a doctor.”
“Doctors forget things.”
Emily’s father, Jack, stood beside them with his hands in the pockets of his jeans.
“Your mother hasn’t slept in two nights.”
Margaret turned on him. “I slept.”
Jack looked at Emily.
“She blinked slowly for about four hours.”
Emily laughed.
“Both of you are ridiculous.”
Jack smiled, but Emily saw something behind it.
Her father wasn’t much for emotional goodbyes.
He had spent most of Emily’s childhood fixing things instead of talking about them. Broken bicycles. Leaking faucets. Cars that wouldn’t start. Problems were easier when they required a wrench.
Daughters flying to Africa were another matter.
He reached for her carry-on.
“Let me check that zipper.”
“Dad, it’s fine.”
“It’s separating.”
“It is not.”
He pulled it closed another inch anyway.
“There.”
Emily smiled.
“Thank you.”
Jack nodded as if he’d completed an important assignment.
Margaret suddenly reached into her purse.
“I almost forgot.”
She pulled out a photograph.
Emily recognized it immediately.
It had been taken when she was eight or nine years old. She was sitting on the bottom step of the back porch between her parents, barefoot and missing one of her front teeth. Jack’s arm was around Margaret, and Margaret was laughing at something outside the frame.
Behind them stood the white farmhouse Emily had grown up in.
“Mom.”
“Take it.”
“What am I going to do with this?”
“Put it in your suitcase.”
Emily laughed. “Why?”
“Because everybody should take a piece of home with them when they’re going that far away.”
Emily looked at the photograph again.
Her father’s hair was still dark in it.
Her mother looked impossibly young.
Emily slipped the picture into the inside pocket of her carry-on.
“Happy?”
“No.”
Margaret pulled her into a hug.
“But better.”
Emily hugged her back.
“Four weeks.”
“I know.”
“I’ll call.”
“I know.”
“I’ll probably call so much you’ll get tired of hearing from me.”
Margaret pulled away and looked directly into her daughter’s eyes.
“I will never get tired of hearing from you.”
Something about the way she said it made Emily look at her for an extra second.
Then Jack wrapped both arms around his daughter.
“Go do some good, Em.”
“I’ll try.”
He kissed the top of her head.
“And come home.”
Emily smiled.
“That’s the plan.”
The seatbelt light chimed.
Emily blinked and looked around the cabin.
Indiana was gone now, hidden beneath the clouds.
Her first flight would carry her to a major East Coast hub, where she would meet most of the Doctors on Mission team. From there, the long overnight flight would take them across the Atlantic to Johannesburg.
Then came several more hours by road.
By the time she reached Eswatini, home would be more than eight thousand miles away.
Emily looked down at the folder on her lap.
DOCTORS ON MISSION — ESWATINI
She ran her thumb along its edge.
Eswatini.
A tiny kingdom tucked between South Africa and Mozambique.
She had read everything Doctors on Mission had given her. Medical reports. Cultural information. Security guidelines. Vaccination recommendations. Maps. Clinic schedules.
She had watched videos and read articles until Africa had begun appearing in her dreams.
None of it made the place feel real.
Not yet.
Emily was a general practitioner, although she preferred the simpler word doctor. She had never been particularly interested in prestige or specialization.
She liked people.
She liked solving problems.
Most of all, she liked knowing that sometimes—on the best days—she could make someone’s life a little better than it had been when they walked through her door.
That was what had drawn her to medicine.
It certainly hadn’t been the money.
She thought about medical school. The endless studying. The sleepless nights. The examinations seemingly designed to make intelligent people question whether they had any intelligence at all.
She remembered the first time she had walked into a patient’s room wearing a white coat and realized the person in that bed expected her to know what to do.
She had been terrified.
Sometimes she still was.
She had simply become much better at hiding it.
Doctors on Mission had been sending teams to Eswatini for several years. The organization worked alongside local healthcare providers, churches, community leaders, and rural clinics, taking medical personnel and supplies into areas where access to consistent healthcare could be difficult.
Emily had volunteered almost immediately after hearing about the trip.
She told everyone she wanted the experience.
That was true.
It just wasn’t the whole truth.
She wanted to do something that mattered.
Something outside the comfortable boundaries of her life.
Something that couldn’t be measured by a paycheck, a promotion, or the number of patients she managed to see before five o’clock.
She had spent so much of her adult life building a career that sometimes she wondered whether she had forgotten to build a life.
At thirty-two, Emily had nearly everything she was supposed to want.
A good job.
A comfortable apartment.
A reliable car.
Friends she loved.
Parents who were proud of her.
Almost everything.
Almost.
There had been a man once.
Michael.
Even thinking his name brought an unexpected heaviness.
She had been certain she would marry him.
There had been a proposal.
A ring.
A wedding venue.
Two hundred invitations waiting to be mailed.
Then, three months before the wedding, everything had fallen apart.
People had wanted explanations.
Her parents.
His parents.
Their friends.
Emily had given them as little as possible.
It just didn’t work out.
That was the phrase she used.
Clean.
Simple.
Final.
It was also not entirely true.
Emily rarely thought about Michael anymore.
At least that was what she told herself.
She looked out the window again.
Maybe that was part of why this trip mattered so much.
She didn’t know what came next in her life.
For once, she wasn’t trying to figure it out.
She was simply going.
Nearly a day later, Emily awoke to the captain announcing their descent into Johannesburg.
She raised the window shade.
Africa.
For several seconds, she simply stared.
The landscape below was nothing like Indiana.
Brown and gold earth stretched beneath them, interrupted by roads, neighborhoods, patches of green and clusters of buildings. Johannesburg appeared gradually in the distance, sprawling farther than Emily had imagined.
She smiled despite her exhaustion.
She was actually here.
At the airport, the Doctors on Mission team gathered around a mountain of luggage, medical supplies and hard-sided equipment cases.
There were twelve of them.
Four doctors. Three nurses. Two medical technicians. A dentist. A pharmacist.
And Dr. Samuel Carter.
Carter was sixty, tall and lean, with graying hair and the permanently weathered face of someone who had spent a great deal of his life outdoors. He had been making medical mission trips to Africa for nearly twenty years.
Emily had met him twice during orientation.
She had liked him immediately.
He walked toward her as she stood beside her luggage.
“You look like someone who hasn’t slept.”
“I slept.”
“For how long?”
“Three hours.”
“That’s not sleeping. That’s blinking slowly.”
Emily laughed.
“My father said almost the same thing about my mother yesterday.”
“Smart man.”
“I’ll sleep when I’m home.”
Carter shook his head.
“That’s what everyone says on their first mission.”
Emily picked up her medical bag.
“And on the second?”
“You realize you were right the first time.”
A woman nearby laughed.
Emily turned.
She was about Emily’s age, perhaps a few years younger, with dark hair pulled into a ponytail and a backpack that appeared large enough to contain everything she owned.
“I’m Rachel Bennett,” she said. “Nurse. Indianapolis.”
“Emily Harper. Doctor. Bloomington.”
Rachel grinned.
“I knew I liked you.”
“Why?”
“Hoosier.”
“Good enough for me.”
Carter motioned toward the waiting vehicles.
“Save the Indiana reunion for the road. We need to move.”
The team began loading their bags.
Then Carter raised his voice.
“Before we leave, one thing.”
The talking stopped.
His easy smile disappeared.
“We’ll go over all of this again tonight, but I want everybody to understand something from the beginning. We’re guests. We respect the people, the culture and the communities we’re serving. We don’t wander off because something looks interesting. We don’t leave the team without telling somebody where we’re going.”
He paused.
“And nobody leaves the compound alone.”
One of the technicians raised his hand jokingly.
“Even for coffee?”
“Especially for coffee.”
A few people laughed.
Carter didn’t.
Emily noticed.
Then his smile returned.
“All right. Let’s go.”
Hours later, Johannesburg had disappeared behind them.
Emily sat beside Rachel as their vehicle traveled toward Eswatini.
The scenery changed as they drove. Towns gave way to open countryside. Mountains appeared in the distance. Small homes and settlements dotted the landscape.
Emily watched everything.
Children walking beside the road. Women talking outside small shops. Cattle grazing beyond fences. Cars and trucks moving between towns. Cellphone towers rising above rural landscapes.
Nothing looked exactly as she had imagined. That surprised her. Perhaps she had arrived carrying more assumptions than she’d realized.
Carter sat near the front, occasionally pointing things out.
As they approached the border, Emily reached into her bag for her passport. Her fingers touched the photograph.
She pulled it out. The farmhouse. Her mother laughing. Her father’s arm around her. Eight-year-old Emily grinning at the camera with one front tooth missing.
Rachel leaned over.
“Family?”
Emily nodded.
“My mother made me bring it.”
Rachel smiled.
“Mothers.”
“She said everybody should take a piece of home with them.”
“She’s probably right.”
Emily studied the photograph.
Yesterday it had seemed sentimental.
Today it felt different.
Home wasn’t simply the place you left behind. You carried pieces of it with you.
She slipped the photograph carefully back into the inside pocket of her bag.
By late afternoon, they had crossed into Eswatini. Emily was exhausted. Her back hurt. Her clothes felt as though she had lived in them for a week. She wanted a shower, a toothbrush and a bed, preferably in that order.
And yet she couldn’t stop looking out the window. The country was beautiful. Mountains rose in the distance, softened by the late-afternoon light. Houses appeared along the road, some modern, others modest. People walked between homes and shops. Children in school uniforms traveled in groups.
At one stop, while Carter spoke with a local coordinator, Emily stepped from the vehicle to stretch her legs.
A little girl stood several yards away holding the hand of an older woman. The girl stared at Emily. Emily smiled. The girl didn’t.
Emily gave a small wave. Nothing.
Then, just as Emily turned away, the child waved furiously.
Emily laughed and waved back. The older woman smiled. It was a tiny exchange. Meaningless, really. But for some reason, Emily felt something inside her settle.
Months of planning. Years of wondering whether there was something beyond the life she had built. Thousands of miles between her and Indiana. And suddenly she wasn’t nervous anymore.
Carter called from the vehicle. “Dr. Harper. Ready?”
Emily turned. “Ready.”
She climbed back inside and took her seat beside Rachel.
As the vehicle started moving again, Emily rested her head against the window and watched Eswatini pass by.
Her mother was probably worrying. Her father was probably pretending not to. Her patients were being covered by another doctor. Her apartment sat empty. Her entire ordinary life was waiting eight thousand miles away.
But for the first time in a very long time, Emily wasn’t thinking about what she had left behind.
She was thinking about what lay ahead.
Four weeks. Four weeks to practice medicine differently. Four weeks to meet people whose lives looked nothing like hers. Four weeks to discover whether coming here could fill the empty place she hadn’t quite been willing to admit existed.
Emily smiled as the mountains grew larger in the distance.
She had traveled halfway around the world searching for something she couldn’t name.
And as Eswatini opened before her, she had the strangest feeling that she was exactly where she was supposed to be.
Chapter 2 - First Day
Emily woke to a rooster.
Not an alarm clock, not the sound of traffic outside her window, and certainly not the muffled footsteps of her upstairs neighbor getting ready for work. This was unmistakably a rooster—a loud, persistent and apparently very angry rooster who seemed to believe the entire compound had somehow slept past an important appointment.
Emily opened one eye and stared at the unfamiliar ceiling above her. For a few seconds she had no idea where she was, which was a strange feeling for someone who generally prided herself on knowing exactly where she was supposed to be and what she was supposed to be doing.
Then it came back to her.
Africa.
Eswatini.
She rolled onto her back and smiled.
“Good morning to you too.”
The rooster crowed again, apparently pleased to have her attention and determined to finish whatever he had started.
Emily reached for her phone on the small table beside the bed and squinted at the screen.
5:47 a.m.
“You’ve got to be kidding me.”
A soft laugh came from beneath the blanket on the other side of the room.
“I’ve been listening to him since five.”
Emily turned toward Rachel Bennett, or at least toward the lump beneath the thin blanket that she assumed was Rachel.
“Why didn’t you wake me?”
“I was hoping he’d eventually give up.”
As though personally offended by the suggestion, the rooster crowed again.
Rachel pulled the blanket over her head.
“He hasn’t.”
Emily laughed and sat up.
Their room was simple but comfortable, with two narrow beds, two small bedside tables, a wooden dresser and a ceiling fan that rotated overhead with an occasional click that Emily suspected would become much more noticeable once she tried to sleep again. Their suitcases occupied most of the remaining floor space, which made walking to the bathroom in the dark an activity that probably should have required a safety briefing.
A screened window stood partially open, allowing the cool morning air to drift into the room.
Emily swung her feet to the floor.
“I need coffee.”
“You and me both.”
“Think they have any?”
Rachel lowered the blanket just enough for one eye to appear.
“If they don’t, I’m going back to Indiana.”
“That seems reasonable.”
Emily walked to the window and pulled the curtain aside.
Then, for a few moments, she forgot about coffee.
Morning was beginning beyond the compound, slowly revealing the mountains she had seen only briefly the evening before. They stood as dark silhouettes against a sky turning from gray to shades of pink and gold, while mist rested low in the valleys between them and the first light caught the tops of the trees. A few small homes were visible in the distance, and somewhere beyond them a thin ribbon of smoke curled upward into the morning air.
Emily opened the window a little farther.
The air smelled different here—earth, wood smoke and something flowering nearby that she couldn’t identify.
“Rachel.”
There was no response.
“Rachel, get up.”
“I’m awake.”
“No, you’re not. Come look at this.”
Rachel groaned loudly enough to make her opinion of sunrise clear, threw the blanket aside and shuffled across the room.
Then she stopped beside Emily.
“Oh.”
For a while neither of them said anything.
They simply stood there watching the sun rise over Eswatini as more of the landscape came into view. Emily had seen beautiful places before, but there was something about this morning that felt different, perhaps because she wasn’t looking at it from a hotel balcony during a vacation. For the next month, this was where she would wake up, where she would work and where, at least temporarily, she would live.
Rachel finally broke the silence.
“Okay.”
Emily glanced at her.
“Okay what?”
“Maybe I’ll stay.”
Emily smiled. “So generous of you.”
The rooster crowed again.
Rachel pointed toward the window.
“But I’m eating him if there’s no coffee.”
Fortunately for the rooster, there was coffee, and Emily decided that was an excellent sign.
By six-thirty, the Doctors on Mission team had gathered beneath a covered outdoor dining area beside the guesthouse where they were staying. The compound consisted of several modest buildings enclosed by fencing, with a central courtyard, a kitchen and dining building and a larger structure that appeared to serve as a meeting room.
Emily wrapped both hands around a mug of strong coffee and breathed in the steam before taking another drink. Across from her, Rachel looked considerably more civilized than she had twenty minutes earlier.
“Better?” Emily asked.
Rachel took another sip.
“I’ve decided to remain with the mission.”
“Dr. Carter will be relieved.”
Emily had met everyone during orientation and again during the long trip from Johannesburg, but names were still in the process of attaching themselves permanently to faces.
Dr. Samuel Carter sat near the end of the table talking with a man Emily hadn’t seen before. Carter, the team leader, had nearly twenty years of mission experience and carried himself with the relaxed confidence of someone who had probably seen almost every possible thing that could go wrong and had learned that panicking rarely improved any of them.
Dr. David Reynolds, a pediatrician from Ohio, was buttering toast with one hand while reading something on his phone with the other. Dr. Lisa Monroe, an emergency physician from Atlanta, had somehow managed to look completely put together despite crossing an ocean and sleeping in a strange bed, which Emily already considered slightly suspicious.
Across the table, Mark Ellis, the team dentist, was good-naturedly arguing with pharmacist Paul Jensen over which of them had snored loudest during the night.
The remaining team members drifted in and out of conversations around them.
Twelve Americans who had crossed an ocean to practice medicine together.
Yesterday they had been mostly strangers.
Emily suspected that would change quickly.
Carter stood and lifted his coffee.
“All right, everybody. Eat while I talk.”
“Best meeting I’ve attended all year,” someone said.
A few people laughed.
Carter waited for the conversation to quiet.
“This morning we’ll head to our first clinic, about forty-five minutes from here. We’ll spend the next several days working there before we move farther south.”
He gestured toward the man seated beside him.
“This is Dr. Thabo Dlamini.”
The man stood. He appeared to be in his early forties, perhaps a little older, and had a calm face and an easy smile that immediately made him seem approachable.
“Dr. Dlamini is a physician and our primary medical coordinator here in Eswatini. More importantly, he’s the person who will keep all of you from doing anything foolish.”
Dlamini smiled.
“Dr. Carter assumes that is possible.”
The table laughed.
“I remain optimistic,” Carter said.
Dlamini looked around at the team.
“Welcome to Eswatini.”
His English was precise and effortless, and there was something immediately reassuring about the way he spoke.
“You have traveled a very long way to help us, and we are grateful, but before we begin, I would ask you to remember something very important. You are not bringing medicine to a place where medicine does not exist.”
Emily looked up from her coffee.
“We have doctors. We have nurses. We have hospitals, and we have very good medical professionals. What we do not always have are enough of them, and we do not always have the resources we need in the places where we need them.”
Emily liked him immediately.
“You will meet patients who have traveled many kilometers to see you, some with conditions that could have been treated easily months ago if care had been available or accessible to them then. You will also see people with problems you cannot solve at all, and for some of you, that will be the most difficult part of being here.”
Something shifted inside Emily.
She had spent years being trained to solve problems. Find the diagnosis. Choose the treatment. Make the referral. Order the test. Even when the solution wasn’t immediate, she was accustomed to knowing that there was usually another door she could open.
She hadn’t given much thought to what it might feel like to know exactly what a patient needed and still be unable to provide it.
Dlamini continued.
“Listen to our nurses. Listen to our community workers, and most importantly, listen to your patients because they understand their own lives much better than you do.”
Then he smiled again.
“If you remember that, I think we will work very well together.”
Emily took another sip of coffee.
She had been in Eswatini less than twelve hours and had already begun discovering that some of the assumptions she had packed along with her luggage might not belong here.
She was starting to suspect that might be one of the reasons she had come.
The road to the clinic wound through hills and small communities, and Emily once again sat beside Rachel, this time with her medical bag between her feet. Dlamini rode in the front with Carter and occasionally pointed out landmarks or explained the communities they were passing through.
Emily listened closely while watching life unfold outside the window.
There were modern buildings and modest homes, shops, churches and schools, along with roadside vendors setting up for the day. Children dressed in uniforms walked toward school, some in groups and others alongside adults, and people waited near the roadway for transportation.
At one point, a group of cattle wandered dangerously close to the road, forcing their driver to slow almost to a stop.
Rachel leaned toward Emily.
“Rush-hour traffic.”
Emily smiled. “Looks friendlier than Indianapolis.”
The vehicle eventually turned onto a narrower road, and after several more miles the pavement gave way to packed dirt.
A few minutes later, Emily saw the clinic.
It wasn’t what she had expected, although she wasn’t entirely sure what she had expected. The building itself was simple, a single-story concrete structure with a metal roof and several windows across the front, with a smaller building behind it.
But Emily barely noticed the building.
It was the people who caught her attention.
There were dozens of them, perhaps more than a hundred, already gathered around the clinic. Some sat on benches beneath trees while others stood talking in small groups. Mothers held babies against their chests, children sat beside parents or grandparents, and several elderly men leaned heavily on walking sticks.
Emily stared through the window.
“Are they all waiting for us?”
Dlamini answered from the front.
“Some have been here since before sunrise.”
Emily turned toward him.
“Why?”
“Because they heard you were coming.”
Before the vehicle had even stopped, several children began waving.
Rachel waved back.
Emily did too.
The moment she stepped from the vehicle, the day suddenly felt different. These were no longer projected patient numbers from a mission briefing or statistics listed in the information packet she had received weeks earlier.
They were people and they had been waiting a long time to get help.
Inside the clinic, organized chaos began almost immediately. Tables became examination stations, medical supplies were unpacked and sorted, the pharmacy team established a dispensing area and the nurses began triage while Carter and Dlamini moved from room to room making sure everyone knew where they were supposed to be.
Emily tied her hair back and slipped the stethoscope around her neck.
Dlamini appeared beside her.
“Dr. Harper?”
“Emily.”
He smiled. “Emily. You will work with Nurse Nandi Maseko.”
A young Swazi woman approached wearing navy scrubs beneath a light sweater. She looked to be somewhere in her late twenties and carried herself with the easy confidence of someone who knew exactly what needed to be done and had no intention of waiting for everyone else to figure it out.
“Nandi knows this community better than anyone,” Dlamini said. “If she tells you something, believe her.”
Nandi smiled.
“He says that because I tell him what to do.”
“I have learned survival,” Dlamini said.
Emily laughed and held out her hand.
“I’m Emily.”
“Nandi.”
Her handshake was firm.
“First time in Eswatini?”
“Is it that obvious?”
“Very.”
Emily laughed. “How?”
Nandi looked down at Emily’s shoes.
Emily followed her gaze.
“What?”
“Those will not survive the week.”
Emily looked at her clean white athletic shoes.
Nandi smiled.
“You will see.”
Emily had the distinct feeling she was going to like her.
Their first patient was a six-year-old boy named Sibusiso, who sat silently on his mother’s lap watching Emily with enormous brown eyes.
His breathing was fast.
Too fast.
The moment Emily saw it, the unfamiliar room and the activity around her disappeared, and years of instinct took over.
She placed her stethoscope against his chest.
“Ask his mother when this started.”
Nandi spoke softly to the woman in siSwati and listened as she answered.
“Three days,” Nandi translated. “Fever and cough. He did not eat yesterday.”
Emily listened again, moving the stethoscope across the boy’s back.
She didn’t like what she heard.
“Has anyone seen him?”
Nandi asked.
“His grandmother gave him something at home. When he became worse, they brought him here.”
Emily continued the examination while Sibusiso watched her closely, his eyes following every movement of her hands.
When she finished, she sat back.
“Pneumonia.”
Nandi nodded. “I think so too.”
Emily looked toward the supply area.
“Do we have antibiotics?”
“We do.”
Relief washed through her more strongly than she expected.
An antibiotic. Something she prescribed so routinely at home that she barely gave a second thought to whether the pharmacy would have it.
Here it suddenly felt precious.
Nandi explained the diagnosis and treatment to Sibusiso’s mother while Emily wrote out the instructions.
As Nandi spoke, the fear in the woman’s face softened, and then she reached across the small space between them and took Emily’s hand.
Emily hadn’t expected that.
The woman said something quietly.
Emily looked toward Nandi.
“What did she say?”
Nandi smiled.
“She said thank you for coming so far to help her son.”
For a moment Emily didn’t know what to say.
Then she squeezed the woman’s hand.
“Tell her I’m glad I came.”
Nandi translated.
The mother smiled.
So did Emily.
By noon, Emily had seen twenty-three patients.
By two o’clock, she had stopped counting.
Respiratory infections, skin conditions, hypertension, diabetes, an infected wound that should have been treated days earlier and a pregnant woman who needed a level of care the clinic simply couldn’t provide.
Then there was an elderly man who had walked several miles because the pain in his knees had become so severe that he could barely sleep.
Some problems Emily could solve.
Some she could at least improve.
Others frustrated her because she knew what she would have done at home, yet those options either weren’t available or weren’t realistic here.
Dlamini’s words from breakfast kept coming back to her.
You will have problems you cannot solve.
He had been right.
Late that afternoon, Emily stepped outside in search of water and a few minutes to sit down. Her back hurt, her feet hurt, and when she looked down, she discovered that Nandi had also been correct.
Her white shoes were no longer particularly white.
Rachel walked toward her carrying two bottles of water.
“You look terrible.”
Emily accepted one.
“Thank you.”
“I mean it affectionately.”
“Then you look terrible too.”
“Fair.”
They found a patch of shade beneath a tree and sat down, drinking quietly for several minutes while life continued around them. Children played nearby, someone inside the clinic laughed loudly at something, and a woman called across the courtyard to another woman Emily couldn’t see.
Rachel leaned back against the tree.
“So?”
Emily looked at her.
“So what?”
“First day.”
Emily looked toward the clinic and thought about Sibusiso, his mother holding her hand, the old man whose knees hurt and the pregnant woman who had needed more than Emily could offer.
“I don’t know.”
“Good or bad?”
Emily considered it.
“Both.”
Rachel nodded slowly.
“Yeah.”
“I helped people today.”
“You help people every day.”
“I know, but this is different.”
“How?”
Emily looked down at the dusty toes of the shoes that had started the morning bright white.
“I’m not sure yet.”
Rachel smiled.
“Give it time.”
The sun was beginning to drop by the time the last patients left.
Emily helped pack supplies while Nandi reorganized the room for the following morning with the practiced efficiency of someone who knew they would be doing all of it again in less than twelve hours.
“You did well today,” Nandi said.
Emily glanced at her.
“For an American?”
Nandi considered the question.
“For someone wearing those shoes.”
Emily laughed.
“I brought boots.”
“Tomorrow.”
“Definitely.”
Nandi picked up a box of supplies.
“Why did you come?”
Emily looked at her. “Here? to Eswatini?”
The answer came automatically because it was the same answer she had given everyone since she signed up for the mission.
“I wanted to help.”
Nandi waited.
Emily smiled.
“What?”
“That is the answer all of you give.”
“Maybe it’s true.”
“Maybe.”
Nandi picked up the box and started toward the storage room.
Emily followed her.
“What answer would satisfy you?”
Nandi stopped and looked at her.
“The true one.”
Emily opened her mouth and then closed it again.
Nandi smiled.
“You do not have to tell me today.”
She disappeared into the storage room, leaving Emily standing there with a question she suddenly realized she couldn’t answer as easily as she had expected.
The true answer.
She wasn’t entirely sure she knew it herself.
On the drive back to the compound, Emily barely spoke.
Rachel fell asleep against the window, while Carter and Dlamini talked quietly in the front of the vehicle. Emily watched the landscape pass and thought about the photograph of her family tucked safely inside her bag, about the patients she had treated and about Nandi’s question.
Why did you come?
She had traveled halfway around the world to help people, and that answer was true.
It just wasn’t the whole truth.
Perhaps she had come because life at home had become too predictable. Maybe she needed distance from everything that reminded her of Michael and the future they had once planned together. Maybe medicine had slowly become more of a job than the calling she had imagined when she first chose it, buried beneath schedules, paperwork, insurance companies and the endless demands of getting people through fifteen-minute appointments.
Or maybe some part of her had simply needed to know whether there was still something in the world capable of surprising her.
The vehicle rounded a curve, and in the distance the mountains rose against a brilliant orange sky.
Emily watched them until the road carried the view behind a line of trees.
She had been in Eswatini for only one day, yet Indiana already felt very far away.
More surprising was the realization that, for the first time since she arrived, she wasn’t thinking about when she would go home.
She was wondering what tomorrow would bring.
Chapter 3 - A Matter of Time
Emily woke before the rooster. For a moment, she lay still and listened to the quiet. The compound was not silent. Somewhere outside, a door closed. A bird called from the trees, and water moved through the pipes behind the wall. But the angry rooster had not yet begun his morning announcement. Emily checked the time. 5:31 a.m. She sighed.
“You’re getting better,” Rachel mumbled from the other bed.
Emily turned toward her. “At what?”
“Waking up before the rooster.”
“I don’t think that’s better.”
“It is if you want to sleep until six.”
Emily sat up and reached for her boots. Rachel lifted her head from the pillow. “Those are not the shoes you wore yesterday.”
“No.”
“Nandi?”
“Nandi.”
Rachel smiled. “I like her.”
“So do I.”
Emily pulled on her trousers, then reached into her bag for the photograph she kept tucked inside. Her mother stood beneath a flowering jacaranda tree, one hand resting on the shoulder of a much younger Emily. She had packed the photograph without knowing why. At the time, it had seemed important—a small piece of home and a reminder of the person she had been before medical school, before residency, before Michael. Now she looked at it every morning. Not because she missed home, but because she was no longer certain what home meant.
The rooster crowed, and Rachel groaned. “There he is.”
“Right on schedule.”
“I hope something eats him.”
“That’s not very compassionate.”
“Neither is waking people before sunrise.”
By six-fifteen, they were seated beneath the covered dining area. The coffee was weaker than it had been the day before, but Emily drank it anyway. Apparently, even bad coffee had its place in the world. Dr. Carter stood at the head of the table with a folder in his hand.
“We’ll return to the same clinic today. The patient load will probably be higher. Word travels quickly.”
“How much higher?” Dr. Reynolds asked.
Carter glanced at the folder. “We don’t know.”
“Comforting,” Lisa said.
Dlamini sat beside Carter, studying a handwritten list. The deep crease between his eyebrows told Emily the list contained nothing good.
“What happened?” she asked.
He looked up. “A nurse from the clinic called before dawn.”
Carter continued for him. “There may be an outbreak of severe diarrhea in one of the surrounding communities. We don’t know the cause yet. Nandi and two local health workers are investigating.”
“How many patients?” Rachel asked.
“At least twelve reported overnight. Possibly more.”
The easy morning conversation disappeared.
“Until we know more, everyone needs to be careful,” Carter said. “Gloves for every patient. Wash your hands between examinations. Keep children with symptoms separate from the general waiting area. If anyone is severely dehydrated, notify me or Dr. Dlamini immediately.”
Emily thought of the crowded clinic and the people who had waited beneath the trees the day before.
“What about the water supply?” Paul asked.
“That is one possibility,” Dlamini said. “There are several others.”
He folded the list and slipped it into his pocket.
“We will know more when we arrive.”
The convoy left soon after sunrise. This time, the villages did not seem quite as unfamiliar to Emily. She still noticed things she could not have named the day before—the brilliant colors of the women’s clothing, the greetings exchanged across the road, the steady movement of ordinary life beginning around them—but she no longer felt as if she were watching from another world. Rachel sat beside her, unusually quiet.
“You okay?” Emily asked.
“I’m thinking about the outbreak.”
Rachel looked out the window. “I’ve worked disaster relief before, but not like this.”
“Like what?”
“Like knowing people may have been getting sick for days before anyone outside their community heard about it.”
Emily understood. The distance between needing help and receiving it could be measured in miles of dirt road, a broken vehicle, a missed phone call, or a clinic without enough staff. Sometimes, it was also measured in lives.
When they reached the clinic, the crowd was larger than the day before. People stood in long lines outside the building. Several women held children who lay limp against their shoulders. A man sat on the ground with his head between his knees. Dlamini was out of the vehicle before it stopped moving.
“Nandi!” he called.
She hurried toward him from the clinic entrance. Her navy scrubs were covered by a pale apron, and her hair had been pulled back tightly.
“The reports are increasing,” she said. “Thirty-seven people from three areas. Most are children.”
“Fever?”
“Some. Mostly vomiting and diarrhea. A few have blood in the stool.”
Dlamini’s face tightened. “Any deaths?”
“Not yet.”
Not yet. The words settled heavily over the group. Carter turned toward the volunteers. “Set up triage outside. Keep symptomatic patients in one area. We need to identify the most dehydrated first.”
The team moved. Emily followed Nandi beneath a broad tree where three children waited with their mothers. One boy in particular looked very ill. His eyes were half closed, and his lips were dry. Emily knelt in front of him. “How long has he been sick?” Nandi translated.
“Since last night,” the mother answered. “He has vomited many times.”
Emily touched the boy’s wrist. His pulse fluttered beneath her fingers, rapid and weak.
“Get oral rehydration solution.”
Nandi was already on her way to the supply table. Emily examined the child while his mother watched every movement. When Emily gently pinched the skin on his abdomen, it stayed tented instead of falling back into place.
“Severe dehydration,” she said as Nandi returned.
They gave him tiny amounts of the solution, waiting between sips so he would not vomit. After several minutes, his eyelids lifted. His mother whispered something.
“What did she say?” Emily asked.
“She says he has not opened his eyes like that since morning.”
Emily nodded but did not allow herself to feel relieved. Not yet.
“What is his name?”
“Sanele.”
“Sanele,” Emily said softly.
The boy looked at her.
“Good. Stay with us.”
Nandi translated, and his mother began to cry. Emily wanted to comfort her, but another child was already being carried forward. Then another. By midmorning, the clinic had become a different kind of chaos. The medical team worked quickly, but not alone. Community health workers moved through the crowd, identifying families from the same villages. Nurses recorded names and symptoms. Dlamini sent a driver to a larger facility for more rehydration salts.
Emily continued seeing patients until the world narrowed to hands, faces, pulses, and instructions. Drink slowly. Stay in the shade. Come back immediately if the child becomes difficult to wake. Do not share cups. Boil the water if possible. Wash your hands. At noon, Carter called her aside.
“We need to send the most serious cases to the hospital.”
Emily looked toward the road. “Do we have transport?”
“One vehicle.”
“That won’t be enough.”
“No.”
There was no frustration in the word. Only fact. Dlamini approached with a mobile phone in his hand. “The hospital can receive four patients immediately. They have limited beds after that.” The familiar pressure returned to Emily’s chest. Limited beds. Limited transport. Limited medicine. There were always limits. At home, she had sometimes been able to pretend there weren’t. Dlamini looked at her. “Emily, I need you to help decide which patients go first.” Her eyes moved toward the waiting area.
Sanele’s mother still held him. His eyes were open now, but he remained weak. A girl of perhaps seven sat beside her grandmother, too exhausted to cry. A baby had stopped vomiting but was breathing rapidly. A young man with blood in his stool lay curled beneath a blanket. Emily looked back at Dlamini. “On what basis?”
“Who is most likely to die without hospital care.”
The answer was simple. The choice was not. They moved from one patient to the next. The young man needed transport. So did the baby. The seven-year-old girl was dangerously dehydrated. Sanele was improving, but not quickly enough.
Four patients. She was being asked to make life and death decisions for only four patients. She said a silent prayer and asked God to help her chose wisely.
When the vehicle finally left, the mothers of the children who remained pressed close to the doors and watched it disappear down the road. Sanele’s mother stood beside Emily.
“Tell her he needs to keep drinking,” Emily said.
Nandi translated. The mother nodded, then touched Emily’s arm. This time, Emily understood without needing words.
By three o’clock, the number of new patients had begun to fall. Community health workers had identified a possible source: a shallow well several families had started using after a nearby pump stopped working. Dlamini arranged for the water to be tested and instructed the villagers not to use the well until the results came back. It was not a solution, but it was a direction.
Near sunset, Sanele’s mother came running from the clinic entrance. Emily turned. The woman was crying again, but this time she was smiling. Sanele stood beside her. He looked tired and pale, but he was standing. Emily crouched in front of him. “Hello.”
The boy stared at her boots while Nandi translated the greeting. Then he reached into his mother’s hand and held out a small object—a carved wooden bird no bigger than Emily’s thumb. Emily looked at Nandi.
“He made it yesterday,” Nandi said. “He wanted you to have it.”
Emily accepted the bird carefully. “It is beautiful.” Nandi translated. Sanele smiled. Emily closed her fingers around the carving. The wood was warm from his hand. For the first time all day, she let herself breathe. On the drive back to the compound, Rachel rested her head against the window.
“You saved him,” she said.
Emily looked down at the wooden bird. “No. We gave him fluids. His mother brought him to the clinic. Nandi knew what to do. The supplies were there.” Rachel was quiet for a moment. “Still sounds like saving him to me.”
Emily watched the landscape darken beyond the glass and thought about the question Nandi had asked the previous evening. Why did you come? The answer still was not clear. Maybe it would not be for a long time. But she knew one thing: she had come expecting to be useful, but— she had not expected to be changed.
As the vehicle climbed the narrow road toward the compound, a figure appeared in the headlights.
A woman stood alone at the edge of the road, holding something against her chest. The driver slowed. Dlamini leaned forward. “Stop.” The vehicle came to a halt, and the woman hurried toward them. She looked about Emily’s age. Her dress was torn at one shoulder, and she carried a baby wrapped in a faded blue blanket. Dlamini opened the door. “What happened?” The woman spoke rapidly in siSwati. His expression changed.
“What is she saying?” Rachel asked.
Dlamini looked at Emily. “She says the baby has been sick for two weeks.” Emily reached for her medical bag. “Why didn’t she come to the clinic?” Dlamini translated the question. The woman answered, her words tumbling over one another. He listened, then turned back to Emily.
“She did.”
Emily frowned. “Yesterday?”
“She came yesterday morning. Before we arrived.”
The woman pulled back the blanket. The baby was barely breathing. Dlamini spoke sharply to the driver. The vehicle turned around, its tires slipping on the dirt. Emily pressed her stethoscope to the infant’s chest. The heartbeat was faint. Too faint.
“How far to the hospital?” she asked.
“Too far,” Dlamini said.
“Then take us back to the clinic.”
The woman clutched Emily’s arm. Her eyes held a question Emily could not answer and a terror she understood too well. Emily looked down at the baby, then toward the dark road ahead. The first day had taught her that some problems could be solved. The second had taught her that time was often the most important resource of all. And now, with the child’s fragile heartbeat beneath her fingers, Emily feared they had already run out of it.
The vehicle reached the clinic in less than ten minutes, though to Emily it felt much longer. She kept the stethoscope against the baby’s chest and counted each shallow breath, afraid that if she stopped listening, the next one might not come.
“Come on, little one,” she whispered. “Stay with me.”
The mother sat pressed against Emily’s side, one hand gripping her arm while the other rested on the baby’s head. She spoke softly in siSwati, repeating the same words again and again.
“What is she saying?” Emily asked.
Dlamini turned from the front seat. “She is telling her daughter that she is not alone.”
The clinic appeared in the headlights. Before the vehicle stopped, Nandi was already running toward them. Carter and Paul followed with the emergency case and a portable oxygen cylinder.
“What do we know?” Carter asked.
“Sick for two weeks,” Emily said as they carried the baby inside. “Barely responsive. Weak heartbeat and severe respiratory distress. I can hardly hear air moving on the left.”
They placed the child on the examination table beneath the brightest light in the clinic. Without the blanket, she looked even smaller. Her ribs pulled inward with every breath, and a faint blue-gray color had settled around her lips.
Nandi slipped the pulse oximeter onto the baby’s foot and waited.
“No reading,” she said.
“Try her hand.”
Nandi moved the sensor while Carter fitted the smallest oxygen mask over the child’s face. The machine flashed, disappeared, then flashed again.
“Sixty-eight,” Nandi said.
Emily stared at the number. For a healthy child, it should have been much higher.
“Temperature?”
“ 35.4°C.”
Too cold. Barely breathing. Critically low oxygen.
“She may have pneumonia,” Emily said. “Possibly sepsis.”
Dlamini nodded. “We need antibiotics.”
Nandi hurried to prepare them while Rachel wrapped warm blankets around the baby’s legs and body. Emily checked her blood sugar and found it dangerously low. They began glucose and searched for a vein, but the child was so dehydrated and cold that none of them could find one.
The mother stood near the wall, watching.
Emily wished someone would take her outside. She also knew she would refuse to go.
After the third failed attempt, Dlamini reached for another needle. “I will try.”
The baby gave a weak cry. It was hardly more than a sound, but her mother rushed forward.
“She cried,” the woman said after Nandi translated. Hope filled her face so quickly that Emily had to look away. For one dangerous moment, she felt it too.
Dlamini secured the line. Nandi gave the first antibiotic, and Emily continued holding the oxygen mask in place. The baby’s chest rose a little more evenly, and the number on the monitor climbed to seventy-four.
Then seventy-eight.
“Come on,” Rachel whispered.
Eighty-one.
The mother dropped to her knees beside the table and began to pray. Emily could not understand the words, but she recognized the name of Jesus when the woman said it.
The number reached eighty-three. For several minutes, it held there.
Emily allowed herself to imagine the hospital. A proper bed. Better oxygen equipment. More medicine. Someone trained to care for a child this sick through the night. If they could keep her stable long enough to reach it, perhaps that would be enough.
Then the baby stopped breathing.
The monitor began to alarm.
Emily pulled away the oxygen mask, positioned the child’s head, and began ventilation while Carter checked for a pulse.
“I can’t feel one,” he said.
Everything moved at once. Carter started compressions. Emily forced air into the baby’s lungs. Dlamini checked the line and called for medication. Rachel moved the mother back while Nandi translated what was happening.
The woman began to cry out.
Emily kept her eyes on the baby.
Breathe.
Carter counted the compressions, his voice steady and controlled. Emily watched the child’s chest rise beneath the mask and waited for some sign that her heart had remembered what it was supposed to do.
There was none.
They continued.
Emily had participated in more resuscitations than she could count. She knew the rhythm of them, the careful timing, the moment when urgency began to give way to the terrible understanding that effort might not be enough.
But this was different.
This child had no name Emily knew. She had no medical history, no chart, and no room waiting for her at a hospital. She had only a mother standing a few feet away, begging people she had never met to save her daughter.
After several more minutes, Dlamini checked again.
Nothing.
Carter looked at the clock, then at Dlamini. Neither man spoke.
Emily knew what the silence meant.
“Again,” she said.
Carter hesitated.
“Please.”
They tried once more.
Emily watched the baby’s face as Carter performed the compressions. She thought of Sanele standing outside the clinic, tired and pale but smiling as he placed the wooden bird in her hand.
One child had stood up.
This one would not.
Dlamini touched Emily’s wrist. “It is enough.”
She kept the mask in place.
“Emily,” he said quietly.
Her hands stopped.
The room became unnaturally still after the machines were silenced. No one seemed to know where to look.
Nandi went to the mother and spoke softly. The woman stared at her, then shook her head. Nandi repeated the words.
The mother crossed the room and lifted her daughter from the table. She held the baby against her chest, wrapped the faded blue blanket around her, and began to rock.
Emily removed her gloves. Her hands felt numb.
“Why did she leave the clinic yesterday?” she asked.
Nandi looked at the floor. “There was no doctor here. The nurse told her to go to the hospital.”
“But she didn’t go.”
“She had no transport. She carried the baby toward the main road, but no one stopped. When it became dark, she returned to her village.”
Emily looked at the woman. “She walked?”
Nandi nodded. “Most of the way.”
The mother said something through her tears.
“She wants to know if her daughter was afraid,” Nandi translated.
Emily moved closer. She wanted to offer something honest, but honesty felt painfully small.
“Tell her that her baby heard her voice,” she said. “Tell her she knew her mother was with her.”
Nandi translated.
The woman closed her eyes and pressed her cheek against her daughter’s head. Then she began to pray again, more quietly this time.
Emily stood beside her until the prayer ended.
Outside, darkness had settled over the clinic. The crowd was gone, and the chairs beneath the trees were empty. Somewhere in the distance, a dog barked and was answered by another.
Emily reached into her pocket and wrapped her fingers around Sanele’s wooden bird. Its carved wings pressed into her palm.
That morning, she had believed the hardest part of medicine was deciding whom to save first.
Now she understood there was something harder.
Sometimes, even after the decision was made, the medicine was given, and every willing hand had done all it could, there was still someone they could not save.