February 2, 2004

Embangweni #17

Dear Friends and Family,

It has been two months since our last message. So much has happened in that time for us and for Embangweni. The holidays were joyful and the much anticipated pageant that we mentioned in our last email was just great. It was outside in the courtyard and many patients, guardians, as well as staff attended. Costumes were interesting! Many made out of sheets and surgical drapes. A lot of green and white. The acting was quite good as each detail in the Christmas story was told. They started with Elizabeth and Zechariah, continued through the birth of Jesus, the wise men, the shepherds (see the attached photo!), and then told the story of the slaughter of the children. They end with the death of Herod. I had never seen quite such a complete story in any Christmas pageant.

We spent three days at Nkhotakota along the lakeshore over Christmas with a group of American and Malawian friends from Embangweni, Ekwendeni, and Mzuzu (see attached picture). For us, the warm sunshine, feasting on Chambo and chips, swimming and sitting on the beach was our first Christmas in such warmth. We remembered our previous Christmas in the cold and snow of New Hampshire with our daughters. We miss them a lot, but we do not miss the cold!

The ARV program is one of only a few in Malawi. We offer antiretroviral medications to employees who are HIV positive and who meet the clinical guidelines for treatment. Leesburg Presbyterian and St. Andrew Presbyterian sent moneys to help get this program started and now Burke Presbyterian (all in Virginia) has pledged $3,000 to continue financial assistance to help employees pay for this expensive medication. There are also some others who have been sending donations as well. Now we have made the decision to expand to other patients who are living at Embangweni and its surrounding areas and can pay full price for the medication (about $32 per month). The cost is very low by U.S. standards, but to a Malawian it is often a full month’s pay. The program requires very close supervision and monitoring. Anyone who does not strictly comply with the regimen is taken off the program. Intermittent drug-taking causes the AIDS virus to become resistant to the medication and that is a huge potential problem here in Africa.

Last Friday Dr. Kamwana and Beth visited the Lighthouse program in Lilongwe to see how they are handling their 800 patients on ARVs and found that they are very excited about a new government initiative to begin ARV programs in 50 hospitals that have been doing testing and counseling.

Embangweni is one of them and is already a leg up since we have started on a very small scale. As we had anticipated, there is global funding for medications which will be distributed through UNICEF to programs which qualify and we hope that when our funding sent by our US friends and churches runs out, this new source of money will be available. We hope to send a nurse soon to Lighthouse for training. This has been postponed twice because the Ministry of Health for the Malawi Government is still working on their training requirements and certification so we do want our people to be
certified.

There will always be a need for more assistance with this fight against HIV and AIDS here. Our testing and counseling program has reached many in the entire catchment area. There has been involvement of village leaders and traditional healers and lots of education out in the villages, but we do not see much change in behavior. I think that most people here can tell you how AIDS is transmitted, but I am not sure how we can go about changing behavior. As they say here pachoko, pachoko—little by little.

With our very serious staffing shortage right now, we do not have nurses and clinical officers available to handle much more than a very small ARV program. We have positions for more staff, but not many want to come to such a rural area—a bush hospital so to speak. The government may be willing to provide the AIDS drugs through UNICEF, but they will not pay more staff. We are handicapped for staff in two ways—funding and housing. The hospital has not been as strapped for cash as it is now since we arrived. Each month we scavenge all the donations that have come in over the previous 30 days to meet salaries and then start trying to pay down the debts for fuel, medicines, utilities, taxes (yes, even in Malawi!), insurance, upkeep, etc. Every month we pay out a little more than we have taken in and go a little deeper into debt. We don't know where the funds will come from for February salaries.

Housing is the other problem. There is no rental housing market here and we don't have enough houses to attract more than about half the approved number of staff nurses. Using all of our capital development funds from the Medical Benevolence Foundation and a grant award from the UK-based BEIT Foundation, we have just invited bids from half a dozen area contractors to build one building with four nurses apartments and one duplex for two senior staff families. But that will only scratch the surface and we have submitted budget requests to repeat the same number of building projects next year. At the same time, we are now soliciting bids for the new integrated preventive health services building that we have mentioned in previous letters. It will be a magnificent facility but a challenge to keep staffed and equipped.

Anticipating the fact that both of our doctors will be leaving at some time later this year—one on furlough and one to pursue a residency in pediatrics—we went on a recruiting trip to Lilongwe this past weekend with Dr. and Mrs. Kamwana. After taking two possible candidates from last year's graduates out of Malawi's one medical school to dinner on Friday night, we came away with a verbal commitment from one of them to come to Embangweni when he has finished his internship this April. Although we will now have to find appropriate housing for him, we rejoice at this positive development.

On the way home we blew out one of our tires and had to change it in the pouring rain, then managed an exciting 180 spin (but no damage or harm) on the very wet, muddy and slippery dirt road that forms the last 15-mile link between pavement and Embangweni. Such is life. This week we are welcoming a group of visiting doctors who will help provide coverage while our own medical staff are attending the Christian Medical and Dental Association's Continuing Medical and Dental Education Conference in Nairobi, Kenya. This is a rare opportunity to help maintain professional skills in an area where we otherwise can only keep our heads buried in the never-ending workload. We are sorry it has been so long since our last newsletter. Perhaps you have glimpsed something of the busy day-to-day schedule that has distracted us from keeping in better touch. We miss that communication far more than our infrequent messages might suggest and we value and enjoy each email and letter that we receive from those of you who send even the briefest of responses. Please keep the letters and support coming!

Wishing all of you the greatest of blessings and peace,

Bill and Beth

The 2004 Mission Yearbook for Prayer & Study, p. 58