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A letter from Darlene and Paul Heller in Malawi

December 14, 2009

Marasmus

Dear Friends

I learned about all kinds of things in nursing school that I promptly stored in the darkest recesses of my mind, thinking “I’ll never need that.” Take marasmus for instance. Marasmus is the most serious form of malnutrition; it’s wasting caused by a protein and calorie deficiency. It happens in infants when they don’t get enough milk. It is always serious, and if it lasts long enough, the infant dies.

Photo of a naked child on white bedding. The child has skinny arms and legs and a bloated belly.

Chawanangwa arrived at the Crisis Nursery yesterday with marasmus, servere malnutrition.

I had never actually seen marasmus until I got here. Now I see it a lot. Just last week we admitted two new babies with marasmus. Emanuel came to us from a faraway village. His mother died after childbirth and dad took the baby home to be cared for by grandma. Grandma and grandpa were willing and appeared able to look after Emanuel. They owned a small shop and had lots of canned milk powder available. They also had a feeding bottle. Yet when we arrived at the home, there was Emanuel — starving. He had gained only 4 ounces since his birth the month before. Why? We don’t know.

Chawanangwa arrived yesterday, from the mission hospital in nearby Ekwendeni. She has been at the hospital for the two months since her mother died in childbirth. Chawanangwa’s elderly aunt was caring for her. During this time she lost more than half a pound. Her aunt was not feeding her enough. Instead, the aunt was diluting the milk she had bought — and even drinking some of it herself. Hospitals here do not provide any food or care; that is up to the family of the patient. Incredible as it sounds, a baby can die of starvation while being a patient in the hospital. Why? God knows.

Photo of a naked baby on white bedding.

Emanuel also has marasmus. If he hadn’t received care from the nursery he probably wouldn’t have survived.

What we do know is that these heartbreaking events are not uncommon. In fact, they are all too common. Without the Crisis Nursery, both Emanuel and Chawanangwa would likely be facing a slow and painful death. Watching little ones like them thrive on the good food and good care provided by our dedicated nannies is the best part of this job.

Yours,

Paul and Darlene

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