February 12, 2005

Dear All,

Some of you will be receiving this message directly for the first time, since I have made a new list of people to send “update letters” to. Sorry to not be writing more, but from my perspective things change slowly here, and I am afraid people will not want to read about the same problems. Our American expectation is that we will see a problem, figure out how to solve it, hopefully obtain resources, watch things get better, and then go on to other things. The reality of Africa is that when we see a problem first we must check to see if anyone else here agrees it is a problem, find out what they think caused the problem and what they have already tried to fix it, see if our solution iseasonable, attainable, and/or acceptable, convince several completely different groups of people that a solution is in their best interest, describe by word of mouth over weeks or months the steps we think should help, try to help people obtain sustainable resources, and watch to see if in fact we have helped any with the problem we noticed in the first place.

An example: families that come to the children’s ward are frequently afraid to get treatment. They have been treated harshly by some members of the health care tree, and therefore usually won’t even give us an accurate history of the problem and what has been tried. When they arrive with desperately ill children they are afraid of IV fluids, NG (nasogastric) tubes, and oxygen, because in the experience of the families, after these things are tried the patient usually dies. I am a strange foreigner who doesn’t speak Chichewa well and am not yet good at convincing families in crisis situations that we can help them. Of course, we have excellent Malawian clinicians and nurses, but they are also often not believed.

Recently we had a little boy with bad pneumonia and malnutrition whose mother took him out of the children’s ward to feed him in order to convince us that he didn’t need an NG tube. Because he wasn’t fully alert, he aspirated the fluids she was giving, choked, and died.

This is not an unusual occurrence here. I think there is universal agreement among families, hospital staff, and missionary doctors that a sick child is a bad problem. If we have several days to work with the families and show them respect and kindness, they often agree to the treatments we propose. Unfortunately, we usually don’t have that much time due to the severity of illness.

I try to learn as much as possible from my Malawian friends and colleagues about how to explain things so patients can understand. And I am learning Chichewa. I have even considered making rounds with an IV and an NG tube. We sometimes try the oxygen on ourselves and the well family members before putting it on the patient, to show them it is not harmful. Is this helping? Only sometimes. My next idea, after discussions with some of the hospital staff, is to go out to the health centers and villages, meet the traditional authorities, and let people get to see and know me before they get really sick. In order to try this I must be able to leave the hospital and to have passable roads to get to the villages. Are we making any progress? I think so because we have 90 kids on the children’s ward instead of the 45 we had last year, so confidence must be growing in the community. But it is a slow process.

From a different perspective, last week we spent hours trying to start an IV on a critically ill child who needed blood. After numerous attempts I was expecting the parents watching at the bedside to be very angry with me. Instead, they simply said, “Thank you for not giving up on our child.” The next day this little boy was sitting up eating chips (french fries), which is the staple food of all sick children at Nkhoma. So we have moments of joy as well as tribulations.

The farmers are pleased that the corn is now as high as a four-foot elephant’s eye, yet the rains have slowed in the last few weeks, so people are anxious about their harvests.

Thanks to all who are thinking of us and praying for us!

Barbara, Melia and Anna

The 2005 Mission Yearbook for Prayer & Study, p. 337