February 7, 2008

Hello Everyone,

The low maternal death rate at Embangweni Hospital attracts many patients, causing overcrowding on the maternity ward.

Last Mother's Day in Malawi, the national papers had articles citing the high maternal mortality in the country—984 maternal deaths per 100,000 births—and the high infant mortality rate in the country—42 deaths per 1,000 births. Last year Embangweni Hospital had three maternal deaths per 2025 births. Because our outcomes are better than other hospitals, many women flock here to deliver, causing overcrowding of our maternity ward. Nurses have to step over patients lying on the floor to treat the sicker patients on the beds. We just had a woman come in who had bypassed a closer hospital and traveled down our mud roads even after her uterus was ruptured and baby dead. We did succeed in saving her life.

Since my return to Malawi this July, there has been a critical countrywide scarcity of essential medicines and supplies. Central Medical Stores is supposed to supply the district hospitals and hospitals in the Christian Hospital Association of Malawi (CHAM), especially for programs that the CHAM units carry out for the government. But Central Medical Stores has for a long time had no basic antibiotics, intravenous fluids, the main medicines to treat malaria, epilepsy medicines besides phenytoin, and most of the safe-motherhood list of drugs. When they are out, we often buy privately, yet even the regular private suppliers have been short. So we have had to pay even higher prices to smaller suppliers who make larger profits. HIV tests have been unavailable in Malawi for months. VDRL, which screens for syphilis, and tests to screen for Hepatitis B have been unavailable since 2006.

It has been tough to keep services going. Once we only had three HIV tests in the whole hospital. Yet, because of your donations, we have mainly succeeded in keeping the essential drug list in stock. Your donations have spared us the tragedy of watching a mother seizing with eclampsia without magnesium sulfate, as a colleague at a sister hospital described. You have spared us wondering if we were transfusing HIV-infected blood when a transfusion was necessary. You have spared us watching many die. Thank you.

The lack of HIV tests nationwide has meant no voluntary testing, which includes prenatal mothers, whose babies would benefit from prophylactic Nevarapine if the mother is HIV positive. When there were not enough tests to continue regular prenatal testing, Embangweni tried to keep the testing going for mothers starting labor. But some births were missed, especially women who delivered at home, in health centers, and out of our catchment area. As a result, we are seeing some babies with HIV-related diseases. These babies—and the babies who are born with syphilis since the out-stocking of VDRL—make me weep.

Since the shortage of HIV tests began, I talked to a friend who was called to be a facilitator at a two-week meeting held at an air-conditioned luxury hotel. The topic: training more counselors for voluntary counseling and testing of HIV. Yes, it is good to have more counselors trained in voluntary testing and counseling of HIV. Yet there were hundreds of trained counselors sitting idle for months due to lack of HIV tests. For the cost of the meeting, they could have bought millions of HIV tests.

During this shortage of basic medicines, President Bingu wa Mutharika traveled to the United Nations in New York. He asked donor countries to fund a cancer research center in Malawi in honor of his late wife, who died of cancer. Many people think it will be funded because, as some say, the president understands donor countries.

I am often asked why the billions of dollars of “aid” from rich countries to Malawi and Africa have not “worked.” Some reasons: Rich donor countries are too willing to fund meetings at luxury hotels that often include consultants and company contracts for glossy publications from the donor country, and per diem payments for local participants who are rarely the village poor. Donor countries are too willing to fund research centers that mainly give contracts to the donor country's universities and companies for consultants and equipment, and whose research findings rarely benefits the village poor. Yes, cancer causes suffering and death in Malawi. Yet, with the life expectancy being 37 years, most village poor die long before they develop cancer. Donor countries are not willing enough to fund programs to ensure essential drugs in the districts or living wages for essential healthcare personnel. Please pray that priorities change.

This month marks ten years since I moved to Embangweni. Living and working here continues to be a blessing and a challenge. Since my last letter I found that I did pass my American Family Practice Board exam in July, so won't have to take that exam for another ten years.

Thank you all for your continued prayers and support.

The 2008 Mission Yearbook for Prayer & Study, p. 23