January 2002

Hello Everyone:

Greetings for the new year, and hope you had a blessed Christmas season. My last weeks have brought new challenges with thankfully countless support. My father turned yellow while shopping for Christmas trees, and had a liver biopsy positive for liver cancer five days before Christmas. Thanks to so much working together, including functioning telephones, local colleagues who assured me they could cover while I was away, and co-missionaries who arranged by trip home and provided hospitality in Lilongwe, I was with my entire family in Oregon, Wisconsin, U.S.A. before church Christmas Eve.

My Dad has had a rough time learning to live with pain, fatigue, and impending death. The success of tube to drain bile may give him some good months. I have a huge wonderful family, each trying to support one another while all at various stages of grief and understanding. Being the doctor in the family is a privileged and a difficult role. For now, I know God wants me to be here. When to return to Malawi is still unclear, depending on the tumor’s growth. Ekwendeni’s hospital staff, the Synod of Livingstonia, PC(USA)’s
home office, and the supporting churches who were informed have
humbled me with their encouragement for my present task and trust that I will know the best time schedule. Rev. Ted Mwambila, the deputy general secretary wrote: "We know your parents are comforted by your presence as a physician, as a daughter, as a servant of our Lord. Our prayers are with all of you for strength, hope and new life."

Since my last prayer letter, I have some good news to report on the prayer points:

Our X-ray department reopened in December following some structural changes, a British volunteer radiographer from Mzuzu Central Government Hospital coming to do short training sessions, and the Medical Council of Malawi only putting in writing that they "strongly recommend" that we close
instead of mandating that we remain closed. No longer do we have to send ambulances full of patients regularly to Mzuzu Central for X-rays, nor guess what the X-rays would have shown for those who could not afford the cost of X-rays there. The changes we have made and further training our staff
received have increased the quality of our films. We have been receiving discarded sutures, mainly from the Rotary warehouse in St. Paul, MinnestoraNow we only reuse and rethread needles for about half our surgeries. Our vehicle situation is improving. We are buying one
ambulance with PC(USA) funds, and will have use of a US-AID/Umoyo Networks vehicle for community health work.

The main hospital challenges since the last letter have been financial—not having funds for running costs to buy medicines and pay staff. We limit what we buy to the WHO essential-drug list for life saving medicines. The plan was to have a three-month stock, which was reduced to a two-month stock, then one-month, then to further prioritize and half what we ordered. We bought medicines to use in October and November from donations that medical students brought each of those months. We are not yet "hand-to-mouth," but only dream about being "month-to-month." It’s frustrating to not be able to take advantage of the lower prices from bulk ordering, to have bad credit everywhere so that we cannot get urgent orders, and to too many crises from running out of something essential.

Then, there is the problem of the staff’s pay. The government in principle is to pay their salaries, but in reality pays about half. Besides the staff getting paid less than their government colleagues, it was made clear in October that they were paid lower than all the other hospitals, including their sister hospitals. Some adjustments were made to partly rectify the situation, but the funds were not forthcoming. So, this past month, the hospital was unable to make payroll. These stressors strain morale, and many nurses and junior clinicians leave, leaving those who remain working most off-days and having as many as 10 nights a month on-call. And themselves wondering if it is foolish to
stay as the season of malnutrition approaches.

Now is Malawi’s season of malnutrition and malaria, and when people are in search of the three F’s: Food, as people run out from the past year’s harvest. Fertilizer, in the hope for a harvest with this year’s rains. And school fees, so their children will not be so dependent for survival on subsistence farming on poor soil and only one growing season each year.

Malawians know struggle and pain, and yet lots of joy. Each day is accented with smiles, laughter, and acts of kindness and solidarity. The lessons they keep teaching me are now helping my family support my Dad in his last stage of earthly life.

Thanks for your prayers.

Martha