A letter from Martha Sommers in Malawi
March 2011
Dear Friends and Family,
I stopped off at Luwawa Forest lodge on my journey back to Ekwendeni from Blantyre, for an overnight and a hike. Listening to the vervet monkeys chatter in the pines and watching the long tailed whydah birds sailing through the blue gum forest cleared my mind of thoughts of medicine, but then my experience walking through the indigenous forest brought my mind back to the challenges of the hospital in a tangential way. Many colonies of ants were on the move after the rains, and I must have been too slow in moving over a colony of pincer ants, for suddenly many were in my shoes and clothing. Even after finding a spot to strip down and kill the ants, their mouths continue to cling to your skin, until you pull each one off. While in the process of freeing my flesh, I was reminded of the story of how surgeons got the idea of closing wounds with staples. During a war, out of sutures, desperate doctors had this type of ant collected, and would hold them over the wound until they bit the edges together, and then squeezed them dead so that they would continue to keep the wound together until removed.
Maternity nurse using double sterile gloves during better economic times. Photo by E. Hohmuth-Lemonick.
Ekwendeni has joined many of the hospitals in Malawi in often running out of — or having to severely ration — sterile gloves and exam gloves, various sizes of needles and syringes, and microscope slides. These are all supplies that we used to wash, sterilize and reuse until about 2005. At that time, the world economy was good, and many international donors, foundations, churches and individuals were contributing to the country’s ability to get rid of this somewhat hazardous practice. Approaching adequate country supplies with an optimistic outlook to the future, rules were made outlawing the reuse of these supplies. So, now in 2011, with the world economy and donations down to maybe half of what they were, the cost of medical supplies up, and the number of patients as high as ever, the situation is pathetic. Scaling down to exam gloves from sterile gloves for deliveries leads to more women with severe lower abdominal pain, fever and foul discharge from postpartum infections, making difficult what should have been happy first days enjoying their new babies. Having no slides available to look for bacteria, fungi and parasites under the microscope makes differentiating one serious disease from another very difficult and results in clinicians trying to treat all of the possibilities, so patients are given many medicines — each with side effects. Although no hospital is considering breaking the rules, there are discussions on whether the rules are making these difficult times worse. I think I am thankful that despite the short supply of sutures, no one has yet suggested that we should be sending staff into the forest to catch those pincer ants to close surgical wounds.
Quotes from today’s The Nation paper include Ken Kandodo, the finance minister, stating, “You can never have enough funding for district hospitals because of limited resources. We can only do what we can but in the next budget we will review the situation.” And Henry Cimbali, the public relations officer for the Ministry of Health, stating that the fuel shortage is not a health issue, when he was confronted with the report that the fuel shortage was resulting in ambulances and backup generators at hospitals not running. These same fuel shortages have resulted in demonstrations, including one in the capital city that was outlawed, and hospitals sometimes having to pay exorbitant black market prices in order to continue to respond to emergencies. These are difficult times with no quick fixes in sight.
I am amazed by the understanding of so many patients and guardians. I had to send the family of one patient in an asthma attack to Mzuzu to buy prednisolone in a private pharmacy when the hospital was out of that medicine. Then, after they returned, had to borrow some of what they bought for another patient who presented with the same problem, but without family with means to buy privately. Beauty within the craziness! Thank you for the privilege of representing you as I journey with the people of Malawi as they persevere, and thank you for your donations that allow us to continue to serve patients.
Wishing you a holy Lent as we look forward to the resurrection,
Yours,
Martha
The 2011 Mission Yearbook for Prayer & Study, p. 67
