You don’t want to miss this interview – it’s an eye-opener to medical care in a place of poverty in contrast to the NHS, it will challenge you to build bridges with those who believe differently to you and that big topic of ‘god and suffering’ is covered by an experienced neonatologist who has seen her fair share of it in the UK and beyond.
Nicci Maxwell is a dear friend and I consider her family. She is about to embark on another long-term visit to Uganda to help mothers, babies and children using her medical skills and knowledge to help those in most need. I am absolutely privileged to call her my friend and am so excited to share her story with you here. Please see her blog and further details on how you can support her at the end of the interview!
Tell us a little about your faith journey!
I was born in South Africa and grew up there. Our parents used to drag us along to church, some weeks kicking and screaming! I got to the the age of 13 and I’d recently joined the church youth group and I noticed that the young people in the youth group – many of whom were three or four years older than I was – had a relationship with Jesus that I knew nothing about. I was really good at the Sunday school stories; I had the full attendance prize every year from the age of four. I knew lots of stories, but I didn’t know a person. I remember quite clearly going home one night and saying ‘Ok God, if that kind of relationship with you is real, I want that.’ He’s been delivering on that ever since!
Did you always want to be a doctor? How did you come to work in neonatal?
I didn’t want to be a doctor. I always thought I was going to be a teacher. When I was 17 I did loads of aptitude tests which were not particularly helpful – they said ‘she can do anything she puts her mind to’. The suggestions were music or medicine. I don’t believe I’m that musically talented – I enjoy music but I’m not sure I could have made a career out of it. I decided to pursue medicine. I remember very clearly before the medical school interview saying ‘Ok God, if I’m meant to do medicine, you’re going to get me in.’ I am woefully unprepared compared to all these clever private school kids I was up against and he got me in!
I did my undergraduate training in South Africa and got to the end of my first year of work. There was a bit of upheaval in the way medicine and jobs were organised at that stage and a lot of my friends and colleagues were having an experimental year somewhere else. I decided for various reasons that the time was right for me to see what it was like somewhere else for a little while. I signed up to come to the UK for six months and that was 20 years ago.
After my first six months, I started on the paediatric process. I chose paediatrics because I wasn’t sure what I wanted to do. I progressed through the paediatric exams and as I had to start making career choices, I’m not sure I made a particular choice to end up in neonatal medicine, but I liked it so I did quite a lot of it and ended up specialising in it.
I then ended up in Cardiff doing a PhD and then moved down to Plymouth to take up a consultant post and it would have been 10 years in November that I’d been a consultant in the neonatal unit there.
What is medical mission?
I was struggling with the balance between medicine and mission. Am I a medical missionary or am I a missionary medic? It might be a subtle distinction but I was really struggling with it. One of my friends put it very clearly saying: ‘All Christians are called to mission. We’re all called to share the good news of Jesus with the world.’ CMS say ‘whether it’s over the road or around the world’. I am called to share that good news in my role as a doctor. In everything I bring to looking after patients, I’m also called to share the good news of Jesus. Whether that’s directly speaking to someone about Jesus – telling them who he is and what he’s done – or whether that’s a little more subtle in terms of the way I treat them with care and compassion which may be something different to what they’ve experienced elsewhere. At Potter’s Village in Kisora, Uganda, we can openly pray for our patients which is incredibly exciting. It’s bringing the gospel by who I am and what I’m doing. My motivation for this is because Jesus loves these people so much.
When did you decide you wanted to do that?
Going back to my teens, I remember watching on TV the Ethiopian famine in the 1980s and thinking, not that I wanted to send them all my pocket money, but that I actually wanted to be there with my own two hands doing something. That was a picture that I carried with me for a very long time and never really had the opportunity to do anything about. Missionaries would come and talk at church and I’d sit there and go ‘but that’s what I want to do – I want to go and do something like that’. I didn’t do a gap year because you couldn’t really do a gap year and study medicine in South Africa in those days. I remember going as far as reading the prospectus for an organisation like Medecins Sans Frontieres but never getting much further.
I knew I wanted to take my medical skills and go and use them to serve people who really didn’t have the benefit of those sorts of skills and go and do something really useful for those who didn’t have anything at all. I kept on having to park that because there never seemed to be the right opportunity. In the period between 2014 and 2015, I started feeling uncomfortable in my job in the NHS. To put that in context, I loved my job. I was a person who got out of bed every morning and thought ‘woohoo, I get to go to work today – what a privilege and a double bonus, I even get paid!’ I would have done my job had they not paid me. I’d gone from that to lying in bed in the morning thinking ‘is there any possibility that I might be ill? Do I have to go to work today?’ That bothered me. I started thinking ‘am I in the right place? What’s going on here?’ Looking back, I think that was God’s push for me to start thinking again about this mission, this call that I knew had been there for such a long time.
I decided to go along to the Developing Health course which is run by Christian Medical Fellowship every year. It’s a two week course – I only had a week off so I only did a week. Originally it was designed as a refresher course for missionary medics coming home, but more and more it’s become something where people who are just exploring the idea of going somewhere can go and see and hear and meet people, learn some tropical medicine and developing world medicine along the way. I think its best asset is the people who are on the course who are working in different places and you can have a chat and get a feel for what it might be like. Within 48 hours of arriving on the course, I knew that this was for me.
I came back from the course and sent some emails to a couple of different mission agencies saying I was a neonatologist. I wasn’t even sure if they could use me and if I had any skills that would be useful. God convinced me that everybody has babies and babies in the developing world have a pretty rough ride. Maybe I did have some skills that might be useful. That was how I came into contact with Church Mission Society (CMS).
CMS got in touch within a couple of weeks I’d had an interview and that seemed to be OK. The said ‘where do you think you’d like to go?’ I said ‘I think I want to go to Africa because it’s in me – I am African! Where shall I go? What should I do?’ Two opportunities came up. One I needed to speak French and I would be teaching at university level and after taking some advice, I felt my high school French was not sufficiently useful and I’d probably have to spend six months really sorting out my language before I could do anything. I was only planning on taking a year away from work.
The other option was a little place called ‘Potter’s Village’ in Kisoro, Uganda. That’s where I ended up. I took a sabbatical year – a year of unpaid leave from my job in the NHS. It miraculously came about as I was told that the trust I worked for doesn’t give sabbaticals. Similarly, the funds, being able to let out my house, being able to leave at the right time – it was very exciting how God lined things up. I went out in September 2016 and had the best year of my life.
What was your role in Potter’s Village?
I was the doctor for about seven of the twelve months that I was there. They had a retired GP from the UK working there for the preceding four years and I’d gone out to assist him. He was planning his long-term return to the UK so for the time I was there he was away for a significant period of that and I was pretty much on my own for quite some time. It was exciting and challenging and I learnt fast. I had an amazing bunch of nursing colleagues who were incredibly helpful and supportive and very knowledgeable. I was blessed and learnt a lot from them as well as being able to give them some of what I came with in terms of skills and knowledge. I can’t wait to get back!
What did you learn from your time there as both a doctor and as a Christian?
Medically, we can’t always make everything better which is pretty different to the NHS. In the NHS we can solve most things to at least some degree, whereas there, I might not have the fancy bit of equipment or whatever I need. The nearest place that has it is so far away that the child would never make it there alive. I’ve learnt a lot about how we care for people in those impossible situations and supporting and loving families and the staff team through those really difficult situations.
For myself, I’ve learnt a lot about looking after my own spiritual growth. I’ve found it quite difficult being over there away from my usual church family. I am so blessed at St Andrew’s (Plymouth) to have an amazing church family and to know every single week I’m going to get a lot of really good teaching. I’d have to be trying really hard not to grow in my faith sitting there because I’m getting so much good input. I’ve found that really different in Uganda. I was getting a lot less and I was having to work harder for myself to just make sure that my faith was continuing to grow and stay strong. That was good for me. That’s something that I need to continue to work on.
Working in neonatal medicine and paediatrics must be an emotional rollercoaster at times. How does your faith help you in this and does it challenge your faith in that role?
I know a lot of people really struggle with the whole ‘God and suffering’ thing. It’s never been something that’s been a big issue for me. I know that sounds very odd. I don’t believe God causes suffering. Somebody once said ‘if it steals, kills or destroys, then blame the devil’. I do believe that there is evil at work in the world and most of the nasty stuff that happens – that’s not what God’s caused. Sadly that’s what we ourselves often cause. Most of the suffering I see in Kisoro is because people are poor. People are poor because they have been badly treated over hundreds of years. They’ve never been given opportunities to develop. God doesn’t cause them to suffer and I believe God wants to help them in their suffering and be with them in their suffering. That’s why he sent Jesus into the world. I believe that some of what I can do there is to actually be there with them and yes, suffering is still going to happen but if there is anything I can do to make that easier or to make them feel cared for and understood in that place of suffering – I believe that’s something of bringing God into that situation.
I’m not sure it does challenge my faith. If anything, it makes me think ‘you know what? God is bigger than all of this. He has got a plan and it is a good plan.’ Even if I can’t see it now. I’ve been thinking a lot about our future hope and what we’re going through here and now for the short time on planet earth is nothing compared to our future hope in heaven.
What are the challenges of working in Uganda compared to working in the NHS?
I think the challenges are – yes, there’s a lack of equipment, yes, perhaps the nurses are less skilled or experienced at this stage. There are challenges in that there are one or maybe two doctors where we’re looking after 16 babies. In the NHS you would have 22 doctors for that many babies! Never mind the paediatric ward that has another 20 children who have an additional 15 or 20 doctors on the rota. There’s some challenges in terms of staffing, in terms of hours… I’m on call when I’m there at least every second night which is challenging sometimes. You get called for different things. They tend to call you out when the child is very, very, very sick where in this country I’ve gotten used to being back up no matter what which is fine. It’s a different way of working.
One thing that struck me hugely when I was there was the expectations of families are so different. Your average NHS neonatal patient – a baby comes in no matter how small, no matter how sick – the family expect that it’s all going to be fine and their baby will get better and they will go home and live happily ever after. A lot of the time in the NHS that’s exactly what happens. I think the expectations in large swathes of the developing world is that both mum and baby are very likely to die and that’s just how it is. It’s such a joy when you can slightly redirect those expectations and go ‘it doesn’t have to be that way – yes, this baby is sick but this baby is going to survive if we do this and this and this’. To see families go home with a healthy child when their expectations were so low – that brings tears every time.
You did some training in cross-cultural mission in the UK – can you tell us a little about that?
Before my year away, I did a two week course with CMS and just after Easter (2018), I had the opportunity to do the CMS Mission Partner Training pathway to prepare me for what’s coming. We thought a lot about culture, other religions, practicalities of mission, what is mission, how does it work, who does it etc, social justice, creation care, empowerment and things like that. There was some theology – a bible overview.
We spent a morning in a mosque which was really interesting. They were so welcoming and warm and willing to share what they were all about with us which was fantastic. As part of my short-term training we spent a day where we started off with tea, biscuits and bible study with the Catholics, and then we walked down to the mosque. From there we went to the Hindu temple and from there we had lunch at the Sikh gurdwara. Everywhere we went people were very warm and willing to discuss and openly share what it’s like believing what they believe and some of the challenges.
I found it fascinating having been brought up in a Christian home and not having a particularly wide exposure to other religions. Some of my friends at junior school were Jewish so I knew a bit about that. A lot of that was new stuff to me. It was interesting to hear their point of view and how they feel they are represented in the media, particularly Islam.
We had a wonderful conversation both times we’ve been to the mosque with a young Imam – British born, British educated who was very willing to talk about what they believe, why the believe, how they believe. I remember quite clearly we said to the Imam ‘what are the challenges that you face on a day-to-day basis?’ and he said ‘car parking and getting our kids to believe our religion’. Yep, I think most churches have similar issues!
People are people as much as we want them to believe what we believe, it’s very helpful and important for them to understand what we we believe and for us to understand what they believe.
You are going back to Potter’s Village – what’s next?
The plan is I’m going back and I will be there until God tells me otherwise. I’ll probably go out for 18 months and then have a spell of leave and an opportunity to come back and visit my supporting churches for about three months. Then I will go back for another 18 months followed by another three months leave. Probably at that point, I will evaluate the situation and see if I achieved everything I wanted to achieve (of course I won’t have!), but how are we doing, what else needs to be done etc.
I will be going back to Potter’s Village but not for all my time. About two-thirds of my time will be there actively seeing patients, covering nights, working alongside their newly appointed Ugandan doctor. He’s recently qualified so I’m sure the two of us will have a lot of skills to share and hopefully I can help him to bring on his neonatal skills which is something that is not particularly well taught in medical school anywhere in the world.
The rest of my time I will be dividing between the government hospital to do whatever I can do to try and improve the care that babies and children receive, particularly as Potter’s Village has to charge for their services. There are still some people who still can’t afford medical care, even at the small price that Potter’s Village charge. I will be hopefully trying to improve things for those as well by being present in the government hospital.
In the district, there are a network of about 14 clinics who also see babies and children. I’ve got a few connections already in those and I am hoping to get out into that wider community as well as some projects that are already running in the diocese – that I will be able to get out into those rural clinics and communities and see what we can do about improving care for babies and children, training for staff and see what they want because it’s not about me going to impose what I think is a good idea, but rather facilitating what they would like if I have that to offer.
Let’s keep Nicci and her whole team in Kisoro in prayer as she continues to serve those with her skills and knowledge and that many people will be treated and blessed through her .
You can support Nicci in Uganda and keep updated by clicking here to her profile with the Church Mission Society.
She also keeps an amazingly encouraging blog and we just love blogs here – check out Crazy Big Plan.