July 2006
Hello everyone:
Life here seems to be periods of intensity followed by light-hearted moments of laughter. The other night is a good example. The watchman ran to my house at three in the morning with a note stating there was a mother in labor with a prolapsed cord. This means the cord had delivered before the baby, quite an emergency. Everyone was quickly assembled and the patient was properly positioned and prepared, and we started the procedure. The baby thrived after resuscitation. The mother’s uterine incision oozed and oozed and oozed, needing more than three layers of sutures instead of the usual two to stop the bleeding. Yet both mother and baby did well.
Then it was time to close the mother’s fascia, a sign that the difficult work is done. I asked for the table to be raised to a more comfortable position, and Mr Tembo said “pumpe” to the circulator. Well, my Tumbuka is limited, but I had never heard that word, so I asked. He explained the manual foot pedal has to be pumped like a bicycle, and as there is no Tumbuka word to pump, the English word is modified. Well, Mr Kayange, who was giving ketamine anesthesia, and is from Rumphi where there is “deep” Tumbuka, could not accept this. He said to use the verb kutiska. This brought laughter, as it is the same verb as “to feed”, and the table did not look hungry. Next, the midwife was saying the verb kukwesa, to raise, would be best—all a clear sign that it was past four in the morning.
By this time, I had scrubbed out and Mr. Tembo was closing the skin layer. I reviewed the case with Cynthia Chikoya, our medical assistant intern who Mr. Kayange was teaching to give anesthesia. I made a reference to Mr. Kayange and Mr Tembo’s experience, and there was more laughter as they pointed out they had been doing this work before Cynthia was born. We then all quickly got home to sleep a little before the day’s work began.
It is great to have these old-timers as the exodus of health care workers from the hospitals continues. An article in the February 2006 journal Reproductive Health Matters, “Tackling Malawi’s Human Resources Crisis,” laments that there are four districts without a doctor in the country and the medical staff ratio of doctors to population is down to 1.1 to 100,000. Since then the ministry of health has been “promoting” doctors from the district’s hospitals to office jobs. Now, five months after that report was published, there are four district hospitals in the northern region alone without a doctor. The only doctor remaining at a district hospital is Charles Muntali in Nkata Bay, who refused the promotion to stay with the patients. We know him well from his student days when he used to come with Dumisani Kamwana to Embangweni to learn and gain experience.
The only doctors outside of Mzuzu in the Northern Region presently are Muntali, Drs. Kyuni and Mughogho at Ekwendeni, and Dr. Kayange and myself here in Embangweni. Not too many to serve close to 900,000 people living in the northern region and not living in Mzuzu. Embangweni’s relative wealth of doctors has lead to an increase of crazy self- and clinician-referrals, bypassing district hospitals to reach here. The minister of health has been replaced. Please pray the new one hears the cries of the suffering.
Since my last letter, we have lost two clinical officers whose training we paid for in exchange for their agreement to work here for two years. Instead, both paid back money for part and all of the time to be served. One stopped in while I was writing this. He is employed by one of the many non-government organization programs and is paid more than double what he was getting here and more than a doctor receives at a district hospital. As he no longer works at a hospital, no longer takes calls, and no longer works Sundays, he certainly looks more rested. Please pray for better reimbursements for the health care staff at the hospitals and health care centers.
Please pray for the family of Charles Nyasulu, our clinical officer intern. His mother died last week from post-partum cardiomyopathy, eight months after the birth of her last child. Charles started his internship three months late, bringing with him his wife and small child as well as his mother and her baby. His mother improved temporarily, but Charles and his family were exhausted. A few weeks ago Charles returned to his village to recruit help from his extended family. An aunt came bringing the wisdom, skills and love that helped them through his mother’s final days on earth. Thankfully, the little children bring some laughter and smiles into their time of mourning.
After complaining of our shortage of health workers, it must seem absurd to tell you of two new/expanded programs at Embangweni. Dr. Sue Makin, a fellow PC(USA) mission co-worker who works as a gynecologist at Mulanje hospital, helped us start up a program of visual inspection of the cervix. This will decrease the number of women who suffer the slow death of cervical cancer, with its pain and months of strong smells and blood loss. Late in the disease, you sadly know the diagnosis by the strong odor even before you have spoken to or examined the patient. This tragedy is too common in Malawi, and thankfully very rare in the United States because of use of Pap smears. Two nurses and a clinical officer have been trained to apply vinegar to the cervix to look for pre-cancerous lesions, and we now have a colposcope and cryosurgery machine to further investigate or treat these lesions. My past experience in these areas while working as a family physician in the United States and the self-study materials from the American Academy of Family Practice have been a much-appreciated bonus.
Our antiretroviral (ARV) program has expanded so that we can and are encouraged to start children in the newly revised Stage 3 and Stage 4 of HIV without having to have a CD4 count. We do not have the capability to do CD4s in our lab, and many patient families were not able to travel for the test, so not able to start the medicines until this new change in the national guidelines. The first-line regime is one quarter or one half fractions of the adult Triomune tablets, which is very workable. When a child needs the second-line medicines, the present guidelines are not practical for the smaller children. Imagine a village woman having to use her kitchen knife to cut an oval tablet in thirds for one of the many medicines she will have to give her child each day—one of the many examples of policy makers expecting poor people with less education and resources to do what would be rejected as impossible for populations with more resources.
This encouragement from the donor community to treat children seems to be a step forward. When we first started treating adults, there needed to be evidence that their treatment would help the economy, and we do and did keep statistics meticulously on how many patients are now back to work. With the children, many under the age of one year, it seems to be more accepted to treat children so that they can be healthy longer and enjoy childhood. Despite literally stepping over patients waiting in our cramped two-room AIDS clinic, the mood is good. We hear the construction of the integrated health building going up nearby, and know soon we will have more space.
We are in early dry season. Harvest has come, still lots of green, and cool breezes. Traveling is easiest as roads are mainly passable. These months we are blessed with many visitors, wonderful personalities who share their love, skills, resources, energy and encouragement. Many have also brought chocolate and Crystal Light, so you know I am appreciating my balanced diet. This is also wedding season. Reverend Mhango returned to Embangweni to perform at the wedding reception of our pharmacy technician, Mtwalo Jere and our nurse, Jane Kaunda. Many of us traveled from Embangweni to Mzuzu for the wedding of clinical officer Mike Nyirenda and nurse Christina Nyasulu, city folks who spent time in Embangweni as students. Please pray for these very sweet newlyweds
An update on nurse Esau Kasonda, who I mentioned in my last letter. He is now a nurse tutor at Ekwendeni’s nursing school, and comes many weekends to lead the survey and follow-up of HIV positive mothers and their babies who received nevarapine at delivery to prevent mother to child transmission of HIV. There is hope of sending him for a master’s degree as Ekwendeni’s nursing school upgrades to hopefully be able to offer bachelor’s degrees in nursing. On top of that, he is soon to be featured on Time magazine’s world health blog profiling a nurse in Malawi. As folksinger Pete Seeger has sung for decades, “You know it’s darkest before the dawn. This thought keeps me moving on.”
I was recently given Tokio Megashio’s modern version of Psalm 23, which includes, “The Lord is my Pace setter—I shall not rush … He prepares refreshment and renewal in the midst of my activity …”
May we all be confident of God’s care and plans for us when we go through life’s difficulties.
Love,
Martha
The 2006 Mission Yearbook for Prayer & Study, p. 337 |
