Moths are dancing in the warm, yellow light of a storm lantern hanging from an overhanging branch of a fever pod tree—kachamira, the locals call the impressive species. A distant rumble of thunder sounds from the mountains in the distance—a harbinger of an imminent storm that has already cut power in the area.
His rattan chair creaks when John leans forward to reach for his mug of tea. He downs the last of it, then stands up to stretch his back. The first drops of rain are falling, so he wanders back inside the house, grabbing another lantern from the dining table since it's already dark inside; the sun is going down behind the thickening cloud cover. As he heads down the hallway, the dancing shapes the lantern light paints on the walls look like shadow puppet theatre.
He finds Sherlock in a small study in the back of the house. An old oil lamp burns on the desk, next to which Sherlock has arranged no less than three old medical textbooks. With the internet connection down, they are all he has at his disposal to prepare for tomorrow's work. John is used to the sight of him spending long evenings studying; there is much in surgery his husband has never learned or has not done for many years. Now, any of those missing morsels of knowledge might be something he needs to save someone's life or limb. Thankfully, he's a fast learner with an eidetic memory and a formidable knowledge base of human anatomy and surgical technique.
In the Western world, Sherlock would have to worry about litigation if he took on an operation he has never attempted before and which he is teaching himself on the go. In Britain, medical improvisation and thinking outside the box would most likely be rewarded with suspicion and condemnation from management. But, out here, anything and everything he attempts is more likely to be met with gratitude and hope.
Sherlock's nose is scrunched up to accompany a thoughtful frown as his fingers skim the text in front of him. John wraps his arms around the shoulders of his husband of four months and presses a kiss into the slightly sweaty curls. The one thing they both miss the most from London is air conditioning. Apart from that, most of the time John feels like he has everything he needs.
Sherlock acknowledges his newly arrived company with a distracted hum and a touch of his fingertips to the arm on his chest.
"Come to bed," John suggests quietly, reaching down to turn off the lantern he'd placed on the floor.
"I still haven't worked out how to construct an approximation of a tibial plate from the ankle fracture sets Joseph found at the back of the closet. That's all we have right now, and the plate needs to be suitable for a patient whose bones are still growing."
Despite the enormous challenges he faces here, Sherlock doesn't sound as stressed as he often has when facing a difficult case at King's College Hospital. Here, his scientific curiosity seems to have reawakened, and he treats all problems as puzzles to be solved, instead of live grenades full of potential for disastrous social faux pas and endless bad consequences in the form of bureaucrats demanding reports.
The price to pay for this newfound autonomy is having to work in very primitive conditions. King's College has clean and consistently running water, storage rooms filled to the brim with endless packets of sterile sutures and proper laparotomy instruments safely sterilised, and plenty of trained staff. Here, at Malosa District Hospital, they have none of those things, but they make do.
Last month, Sherlock had diagnosed an acute brain bleed in trauma patient from a car accident without any brain imaging at his disposal. He had spotted a Cushing's triad of uneven breathing, bradycardia and high systolic blood pressure, combined with abnormal pupil size and reactivity. They'd rushed the patient into the hospital's only OR only to be told there was no cranial drill available. Unfazed, Sherlock had ordered his assistant promptly to fetch the village carpenter to borrow his gear. The patient had emerged from anaesthesia alive and only slightly confounded after her acute traumatic subdural hematoma had been successfully drained. A week after she had been discharged, her husband had gifted a baffled Sherlock with the only goat they owned. He'd tried to decline but Louise, their Malosan housekeeper and cook, had informed him that he'd gravely insult the poor man if he wouldn't accept the gift. The resourceful Louise, who has been indispensable to how well they have settled in, had then solved the issue by gifting the goat back to the family three days later by saying it was a donation from the hospital.
John had grown quite fond of the goat during those three days it had spent tied to a tree in the front yard even though it had eaten half of John's favourite T-shirt. Sherlock had named it Anderson 'since he bleats as much'.
"Did they tell you that the autoclave's finally fixed?" John asks him, referring to a machine which sterilises surgical equipment with high-pressure water steam. He starts kneading his thumb tips into the tightly knotted muscles on the back of Sherlock's neck, which brings forth a sigh and a shudder.
"A fat lot of good that will do if the electricity doesn't come back on. I don't trust the spare generator further than I could throw it." Sherlock sticks his fingertips into his messy curls and gives them a shake. "Did you speak to the Minister about assigning an officer to curate the distribution of supplies to regional hospitals?"
"His secretary says he'll take my call tomorrow."
The entire country of Malawi has long suffered from an inefficiently run public healthcare system where tertiary hospitals get the first pick of supplies, and very little of them trickle down to secondary district hospitals and rural clinics. After years of being head of operating room logistics at King's, John hasn't hesitated to try to influence the powers-that-be to fix the most glaring issues. Jens-Erik and Åse, the Norwegian married doctor couple with whom they form the hospital's tiny pool of doctors, have told him they've been trying to change the same things for years, to no avail.
Palms resting on his partner's shoulders, John leans further over them to better see the images on the pages of the well-underlined textbook Sherlock is consulting. Colleagues from King's had sent boxfuls of their old ones over after they'd sent an email request requesting them. The internet here is, at best, fickle to function, so it's hard to check things online.
"You really enjoy learning things on the run, don't you?" John points out.
Sherlock twists his torso to look at him. "It still surprises you." He sounds mildly dismayed.
John grabs the edge of the cover to glimpse the title of the book—an old edition of Wessel's Operative Techniques in Trauma Surgery. "I guess it does. Mostly, I'm relieved. Wouldn't have wanted you to be stuck here for eight months, hating every moment."
"I did do my research before deciding."
"I know, love."
Who would have known that Sherlock, of all people, would be such a good match for rural healthcare in a developing country? He has embarrassed John so many times already by breezing through situations and challenges which John would have assumed would be much more difficult for him. Then again, there have been many things Sherlock has found difficult which have not bothered John at all, things he hadn't even realised could be challenging to someone. After all these years, when it comes to understanding Sherlock, he still often feels like a beginner. Through the years, there have been so many things Sherlock has learned, managed, and overcome against the assumptions of others. Those lessons have been hard-won, but they have been very, very necessary for the survival of their relationship.
And, not just survival—for its recent thriving.
But, how did they get here? How did they end up in rural Malawi, after spending years living a hectic life and building high-powered careers in London?