A letter from Barbara Nagy serving in Malawi
September 2014 - Improvements and Challenges
Dear Friends,
Walking into the Nkhoma Hospital pediatrics ward after a two-year-long study leave is an exciting experience! A major renovation that was under way when I left in 2012 has been completed, and the outcome is wonderful. For the first time in my tenure in Malawi we have a bed for every patient and adequate space for the staff to get to the patients for care. There are plugs for oxygen and other pieces of equipment, which are crucial for taking care of these small lives.
There is a beautiful, open triage area where the sickest children can be quickly stabilized while the limited nursing staff can keep visual check on the children already in the ward beds. Turning around in the triage room you see a large sink and bank of cubbyholes holding everything necessary to care for a sick child. Trivial as these things may seem, they are the difference between life and death when a wave of critically ill children hits the pediatrics ward, sometimes more than 100 in a day, with only a few nurses and clinicians.
We were also able to add isolation rooms, so that new patients with important infectious diseases like meningitis, measles, tuberculosis, rabies, or cholera may safely be cared for on our ward without risking exposure of others. A small nursery was constructed for children born outside of Nkhoma Hospital, with a ceramic heater high up on a wall to prevent burns. It is home to three tiny triplets who were dying of malnutrition in their village but now are slowly gaining weight as we try to support their family to provide care after they are discharged. Food from the Nickel a Meal program will go home with them to support the mother’s nutrition until the babies are old enough to take solid food.
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Nkhoma Hospital Ward
I am extremely gratified that patient care improvements we started before I left are going strong, a testimony to the dedication of the staff since these things are labor-intensive. The survival rate of children admitted to the pediatrics ward remains very high for a resource-limited hospital. Three little patients are quickly admitted, fighting for their lives, on the first day I make rounds. An 18-month-old has a severe pneumonia and despite all the support we can offer him, his oxygen level is barely acceptable. A Malawian medical student is assigned to watch him closely, and after three days we are gratified to see that he is going to make it. A severely malnourished child is admitted with very low body temperature, barely alert, and we are able to immediately start high-calorie therapeutic milk and to warm him. He is also significantly improved after a few days but will take much longer to fully recover. Sadly, so many children in Malawi suffer the effects of chronic malnutrition that education is very difficult. Finally, a child with cerebral malaria is unconscious for nearly a week before finally, slowly, improving enough to sit up unassisted. His family does not own a bed net.
What would my public health training say about these three children? It might point to sanitation and nutrition at the home level. It might talk about the risks of using open fires for cooking, which are equivalent to smoking two packs of cigarettes per day for the mother and the baby inevitably strapped to her back. It would certainly investigate the availability of insecticide-treated bed nets in the community, highlight the benefits of having a village health worker close at hand to treat these children before they become severely ill or facilitate forming community health teams to make provision for transporting patients to the hospital when needed. Our commitment as a health care institution, and as the PC(USA), is to try to ameliorate root causes of poverty and illness as well as show Christ’s love by helping those who are ill.
One challenge I noted upon returning to the pediatrics ward is that many vital pieces of equipment have broken. We have one partially broken nebulizer for asthma meds being shared between three wards, no oxygen saturation meters and no pediatric blood pressure cuffs to monitor a newly admitted boy with kidney disease. Given the constant financial distress of the hospital, the presence of an experienced senior clinician is needed to help prioritize expensive equipment repair and replacement costs. Presently the hospital’s X-ray machine has been broken for months in spite of two costly visits by an X-ray repair person from South Africa. Only smaller patients who are able to stand can be X-rayed using a mostly broken old portable unit.
It is much more costly to run a hospital than a primary and preventive health program, yet these community programs depend upon a functioning referral hospital for supervision and support, and a referral hospital is vital to the system of medical education within the country. A significant percentage of medical professionals in Malawi have received their training in mission hospitals, where values of excellent care are offered along with service out of love and respect as opposed to the desire for monetary gain and acclamation.
Nkhoma Hospital also hosts medical students from abroad, usually including special projects as part of their studies. One of recent interest was determining how health centers are screening for NCDs, or non-communicable diseases, like diabetes and hypertension. The students found that none of the health centers around Nkhoma Hospital could screen for diabetes, and only a handful had any functioning blood pressure cuffs at all.
Catching people when they arrive for no matter what reason is often the key to providing vital health services in a place where routine medical care is non-existent. People with hypertension often meet the health care system when they have strokes or heart failure, and people with diabetes may arrive with severe foot ulcers leading to amputation of limbs. Obviously a better system would help improve the lives of many in our area. One woman came to a local health center as a helper to her sick neighbor and underwent cervical cancer screening just because it was there. She was found to have a cervical cancer and was quickly referred to Nkhoma Hospital for surgery, which we hope has saved her life.
Our family is dealing with a learning disability and looking for a volunteer to help with the education of a primary student if there is an interested person available. We deeply appreciate all the financial gifts and prayers that have been offered by members of our supporting congregations. We could not do what we do unless you are supporting us.
Blessings and joy from all of the Nkhoma community,
Barbara Nagy and girls
The 2014 Presbyterian Mission Yearbook for Prayer & Study, p. 143
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