Friday, 15 May 2015

I LOST MY SON… but his memory taught me how to live

When Ruthie Markus’s son died at just 23, she was determined to set up a charity in his name. But she could never have guessed how it would change her life forever

Written by Ruthie Markus
There isn't a rule book telling you what to do when you lose a child. Friends would cross to the other side of the street rather than speak to me – I represented their worst nightmares. Most simply didn't know what to say. Others were heroic, rousing me from the depths of despair, when I could not get up from my kitchen floor.

A month after my only son Alex committed suicide, at the age of 23, I determined to set up a charity in his name. Something that would make his life continue to count.

I sat at the kitchen table with a pack of Post-it notes and arranged the words Africa, Alex, Medicine and Education into Alex's Medical and Educational Clinic in Africa. That was the genesis of the name and how The AMECA Trust came into being.

Having lost all the things that every parent looks forward to – seeing Alex realise his dreams, celebrating landmark birthdays together, becoming a grandparent – I needed a way of keeping him alive, and this was it.

CharitySon-May15-01-590Alex in Lesotho in 2006

Now, my son is even larger in death than he was in life.

Alex was an adventurer. He would do mad, brave things – like hitchhiking to Baghdad with an Army friend just after the fall of Saddam Hussein. And he adored Africa. While training to be a doctor on a scholarship with the British Army, he spent his elective [medical work experience] in Kenya. To him, the challenge of rural medicine was a great thrill.

I shared his enthusiasm for the country and we enjoyed horse riding in the African bush. Had he lived, Alex would have continued his career as an Army doctor, I am sure, and probably chosen to work in some terrifically difficult and remote part of the world. Creating a charity with the core aim of improving medical facilities for the long term, in places with real need – through teaching – felt like a synergy of our beliefs and skills.

Before Alex died, I was a teacher. One of my first jobs was at a school in Croydon working with young offenders. Rather like Alex, I have always relished a challenge. He never chose the easy path.

CharitySon-May15-03-590Students on fundraising challenges in Malawi

When I first landed in Malawi, I didn't know anyone. With no car to get around in and no friends, it was lonely. But I always felt safe – even as a single female. The locals had seen NGOs and projects come and go, so it took time to win their trust – they watched and waited. Now, seven years on, it feels like home and I have a permanent base, which we spent days scrubbing into shape and furnished with gifts from friends.

I have a strict rule never to stay in hotels – I would rather walk on hot coals than waste donor funding – though sometimes I dream of a fully functioning bathroom.

My days in Malawi are full to the brim with myriad colours, smells and sights – along with dust, heat and, recently, enormous thunderstorms – as well as feelings of frustration. Meetings are often held on the doorsteps of open-air huts with local chiefs, and getting about (especially in the rainy season) is a terrifying business. The roads are truly awful, with cars slipping all over the place in the mud. The smallest thing – something you'd do without thinking at home – can seem a huge battle. The other day it took me a couple of hours simply to get hold of a gas cylinder. There is nothing romantic about my travel in Africa.

But then Malawi grounds me and the time here simply disappears. I feel closer to Alex when I am here. Partly because people talk about him all the time. They do not shy away, or look uncomfortable if I mention his name. Whereas if I am at a dinner party in the UK and share an anecdote about Alex, that will often silence the table.

CharitySon-May15-04-590Right: Ruthie with AMECA’s clinical director, consultant surgeon Paul Thomas, and two Dutch surgeons

Death is more real in Africa, more a part of people's day-to-day. It is deeply gratifying that AMECA is now considered one of the more effective medical charities working in Africa, though that doesn't stop me constantly worrying about where we will find new funding and how we will get projects off the ground. I wake in terror every single day, and a good day is when a cheque arrives in the post or a new donor signs up.

I can't begin to repay the people who've helped me along the way. One of our advantages is that we are a small charity. My office is at home – it is essentially a desk on the landing – so our running costs are minimal. Volunteers are all friends, all professionals, and we don't waste money. Alex's Army friend, the adventurer Levison Wood, is one of our patrons.

Our approach is focused, based on what is needed rather than what sounds a good or fashionable solution. Our student fundraising challenges might involve painting a brightening mural in a local primary school or reinforcing one of the many rickety bridges that cross rivers, and we use the funds from these for our medical projects. In May 2012 we built a fully sustainable hospital wing onto a paediatric orthopaedic hospital in Blantyre, Malawi's second largest city, to raise funds for free paediatric orthopaedic treatment.

Our current project is the construction of a clinic for a remote community of roughly 22,000 people who do not have access to primary health care, a result of which is that people die from all sorts of treatable illnesses – even simple tooth infections. The new clinic will be located in Chilaweni Village, South Lunzu, and will provide basic primary care, an underfives clinic, mother-and-child services, an HIV and Aids clinic, dental services and more. There will also be an ambulance to transport emergency patients to hospital.


AMECA also provides bursaries (£62,000 worth, so far) for less well-off medical students, nurses and physiotherapists to help fund their electives in Africa. It's an experience few of them forget, especially because diseases present at a much later stage than in the UK and basic medical equipment is so often unavailable.

And it isn't just the young who get involved. Last year we took a group in their 50s and 60s out to raise money by climbing Mount Mulanje. They also went into the community, met the villagers – who gave them the warmest possible reception – and helped to fit windows into the primary school. They loved it! Why should the youngsters have all the fun? We can tailor a challenge to suit a group, no matter their age or skill set, and I promise it will be life-changing.

Our doctors and surgeons come out and train local clinical officers, leaving them equipped to treat patients long after we've left. This is the cornerstone of the charity. I have seen too many failed projects in Africa where donor money is wasted because no training is put in place to keep things going. The number of buildings with rusting equipment is dispiriting, especially when people donate funds in good faith. In one case a CT scanner was given to a very small, rural clinic, which had no electricity most of the time.

There are only 256 doctors in the country and 11 surgeons, so meeting people's medical needs is a constant challenge. The last thing we want is for our surgeons to come in, operate on 80 patients and leave, because what happens the next day?


We also try to make things as costeffective as possible – for example, using sterilised mosquito netting to repair a hernia. That costs less than 20p per operation, compared to £20 on the NHS.

I know about making modest sums stretch. Life was hard when Alex was growing up – I was a single mother working during the day and tutoring in the evening so I could send him to a good school, St John's in Leatherhead. Even chocolate digestives were a treat. But it did mean that Alex valued his education (except when he was a grumpy teen). Seeing how much children in Malawi appreciate learning gives me enormous hope.

CharitySon-May15-07-590Left: Alex on an expedition with the adventurer Levison Wood. Right: Alex in Kenya during his elective

The only things I miss about England are BBC Radio 4 and The Archers. My survival kit contains a head torch, a gas-operated hair curler, sunglasses, Nivea and a suitcase loaded with strong Cheddar and Twiglets – for my expat friends.

Africa is by no means easy, but I have come to realise that in England I exist, while in Malawi I live.

To find out more and to donate to AMECA, visit

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