November 9, 2006
Dear Friends,
Three recent stories that give a sense of what it’s like to live here.
Lack of syringes
It is Sunday evening about 6:00. Twilight is falling as we return home. I find a note stuck in our door saying that the hospital has been completely out of syringes since midmorning and requesting that I go there to get more out of storage. This does not surprise me. Due to financial difficulties, the hospital never has enough supplies, and we are constantly short-supplying the wards and health centers. We always keep a few for emergencies, and this has now become one. On my way to the hospital (about a five-minute walk) the electricity goes off all over the station. The storage area is therefore completely in the dark. Fortunately I know the place so well that I can feel my way down the aisles of surgical supplies to find where the syringes are kept. Even more fortunately, every size of syringe comes packed in a different sort of crinkly wrapper so I can tell which is which just by the sound of the wrappers. 20cc syringes sound like old ladies unwrapping hard candy in symphony halls, 10cc syringes sound like microwave popcorn being opened, 5cc syringes sound like soft plastic hotdog wrappers, and 3cc syringes are in hard containers.
After picking out the necessary supplies I head down to the wards where there is a single solar light in most areas. I find the patients sitting in the breezeways talking softly in the gloaming. The nurses on maternity are the only ones in the hospital, and they quickly disperse to the various wards to give people the medicines that have been awaiting the arrival of syringes all day. Life returns to normal.
Lack of meningitis medicine
It is Tuesday in the outpatient department. I am seeing the last patient of the morning when a couple with a young baby pushes into the exam room, very unusual behavior for Malawians. The child is nearly dead, so we run to the children's ward and start resuscitation. Only nursing students are available to help, but they do a great job. An emergency tray is brought to the patient's bedside, oxygen is started and one of the students gets a crash course in assisted ventilation while the others are getting IV drips, emergency medicines, antibiotics and quinine, and are drawing labs. Within a few minutes we have an IV started and the baby responds well, breathing on its own with a steady pulse, and becoming more alert. I think things have gone well, but since we lack any real intensive care I have to leave the parents to watch the baby with instructions to call a nurse if the baby stops breathing again. Unfortunately this is not sufficient, and the infant dies later on that day.
I reviewed her chart and saw that she had been seen at one of our health centers the previous day with a presumptive diagnosis of meningitis and referred to Nkhoma. She was given only a single dose of gentamycin, not a drug that treats meningitis well, and it took her parents a whole day to make it to the hospital. I am fairly sure this treatment was given because the health center in question had run out of the right drugs because we didn’t supply them with enough. Usually children in this situation are given appropriate therapy that gets them to the hospital alive even if there is some delay. I am wondering how many others are suffering due to lack of supplies at the health centers.
Lack of diagnostic facilities
It is Friday in the outpatient department. I am seeing a very sick young woman who has been to clinics and hospitals throughout the central part of the country. She has AIDS, and although her health passport (portable medical record) details that she was eligible for treatment months ago, no one seems to have realized this. She checked out of the previous hospital due to her family's concern over her deteriorating condition and came to Nkhoma. She is confused and barely able to stand, with a high fever. A lumbar puncture is done with great difficulty, as she is unable to cooperate. Unfortunately, the lab has broken the coverslip to the special slide they use to count white blood cells, so they are unable to give us any results. A chest Xray, which might help us, is also not possible. Like my daughter doing fourth grade math, we are using the “guess and check method” to treat this patient. I sincerely pray to guess well. We start treatment for meningitis, dysentery, and pneumocystis, a classic case of polypharmacy that we are taught never to do in the United States. Fortunately we have guessed right, the patient starts to recover, and a repeat lumbar puncture several days later proves that there was indeed an AIDS-related meningitis. By this time the patient is sitting up in bed responding to questions—not well, but definitely on the road to recovery.
I am telling you these stories to illustrate several things. First, the significant suffering and chaotic care that happens when we run out of vital things, which is now constant. I know that people in Western North Carolina and elsewhere have sent support recently, and we are very, very thankful for this. The current international debt relief for Malawi and a government anticorruption campaign promise to offer some limited help to people in the future, but always there is a vast gap between the costs of simple treatments and what is affordable for the average Malawian. It currently costs about 500 dollars per day to keep the hospital and 10 health centers stocked with basic drugs like penicillin, magnesium sulfate, and quinine and supplies like gloves, sutures, and syringes. I am wondering if individuals or churches would consider making a day’s contribution.
Second, I want to highlight the importance of the health centers. It is usually more expensive for a patient to travel to the hospital than to pay for their hospital care, including surgery in many cases, and delays in care are causing many problems. Despite all our struggles, Nkhoma is seen by the community as a place of hope, a place where they will receive the best treatment available, and where we can be trusted. I value this trust very deeply and think it is the vital factor that will change people’s lives and health in the long run. Not simply money—money is necessary but it is not sufficient to produce change—but trust, which becomes faith as we walk together towards God’s vision of wholeness for each of His children.
Peace,
Barbara
P.S. To those who have not heard from us in a long time, I apologize for sending you a “begging letter,” but after thinking of the situation of the people in our area I felt I needed to let their situation be more widely heard. We do think of you, but as you can see above, the demands of caring for these patients can be overwhelming and it is very difficult to get letters written. The hospital is going through a lot of struggles now, but it has also progressed in many areas that have the possibility of significantly improving healthcare for people widely around Nkhoma. Stay well! We miss you.
The 2006 Mission Yearbook for Prayer & Study, p. 337 |
