Malawi Mission Trip

Thanks First Pres Youth for the cards. We appreciated your prayers, humor, encouragement and artistic creativity. Thanks Jennifer for the birthday card. Thank you all, for praying for us during my three week trip to Nkhoma Malawi. I felt such strength knowing prayer warriors were going before me and standing beside me.

During the month of January when malaria was at its height there were 1,061 children admitted to the pediatric ward with an average census over 200. The blood bank reported 400 units of blood transfused during that time. Imagine my relief when I found only 148 patients on arrival. Several clinical officers, Malawian, Dutch and Norwegian nurses, Scottish, Malawian and Dutch medical students made up the team. We were quite the international group. There was a good spirit of comraderie and unity inspite of the language and cultural differences.
I spent my first day with the sickest children, several in status epilepticus (convulsing) at the same time. I found myself moving from bed to bed ordering diazepam, phenobarbitol and phenytoin. Most of the children had severe malaria; cerebral malaria with convulsions and coma, life threatening anemia in heart failure requiring emergency blood transfusion or heavy parasitemia requiring IV quinine. Most of the children were under 5 years of age.They have little to no immunity which is only gained after multiple bouts of malaria over time. Critically ill children requiring oxygen were placed in six beds with two to three per bed to be close to the oxygen concentrators. In addition to malaria,TB, pneumonia, meningitis, malnutrition, diarrhea and AIDS were common diagnoses.

Amy's blood

Malaria is found in over a hundred countries and the parasite threatens 40% of the world’s population causing over a million deaths each year. Malaria kills 2 children every minute in Subsaharan Africa. Malaria in a pregnant woman increases the risk of maternal death, miscarriage, still birth and neonatal death. Nine to fourteen days after being bitten by a mosquito carry plasmodium falciparum symptoms occur including fever, chills, sweats, cough, diarrhea, anorexia, nausea, vomiting, muscle and joint pain, headache, and lassitude. The most important severe manifestations are acute encephalopathy (cerebral malaria), severe anemia with heart failure requiring transfusion, renal failure, hypoglycemia, respiratory distress, coagulation defects and shock. Case fatality rates among untreated children can reach 10-40% or higher. Treatment involves checking a blood smear, doing a rapid malaria test for p. falciparum, monitoring blood glucose and beginning IV quinine and medication for fever. When the hemoglobin, normally around 12, falls below 6 a blood transfusion is given. Children in heart failure from severe acute anemia require blood immediately. It is life saving.

There are preventive measures which can be effective in reducing infections. One method is using insecticide treated mosquito nets at night when the anopheles mosquito is active. Although these bed nets cost less than ten dollars each, families living on less than a dollar a day cannot afford them. Indoor residual spraying with insecticides is another preventive method targeting the adult mosquito. It must be applied before the transmission season and coverage rates must be high. It is expensive. This year funding for indoor residual spraying came late and there have been fuel shortages. Avoiding going out between dusk and dawn is unrealistic when people live in mud huts without doors or screened windows and when they cannot afford insect repellent or daily prophylactic medications.

Each morning, I awoke in the dark between 5 and 6am and read from 40 Days with Jesus the devotional sent by the mission team. It lifted my spirit and guided my thoughts. On Day 3, I read, "Follow me one step at a time. I will equip you thoroughly. Keep your mind on the present journey. Walk by faith, not by sight." I started rounds between 6 and 7 am with prayers in Chichewa with the guardians, mostly mothers, asking God for wisdom for the staff and healing for the children. Then I would begin, "Mwauka bwanji?" How have you woken up? Ali bwanji? How is he/she? I worked with a wonderful young man, Pearson, as my translator, who was eager to help me to improve my speaking. I tried hard not to look at the masses but to look at each one placed before me. I learned the children's names and tried to look in the faces of the mother's, touch a shoulder and smile.
People are filled with fear of witchcraft, sorcery and curses. They frequently delayed coming for care while they sought help from a traditional healer. They wear protective aumulets and herbs and strings.

Two weeks after admission

One boy of 11, Khalani, was carried in emaciated and jaundiced covered with scarification. There were small one centimeter scars in rows up and down his arms, legs, chest, back, neck, abdomen and forehead. Some were fresh and scabbed while others were well healed and hypo pigmented. I wondered if his jaundice was due to hepatitis from unsterile blades used by traditional healers.  During the morning, the clinical officers would send puzzling cases to me for advice some from the outpatient department like a young boy with bilateral proptosis of the eyes which could have been due to Grave's disease, hyperthyroidism or a malignancy but there was no way to be sure (Thyroid tests are not available and there is only one CT scan machine in the entire country far from Nkhoma Hospital). I did email a few photos of rashes and x-rays to my ID consultant in Zambia via Blackberry technology.

scarification from traditional healers

Every day 20 to 25 new patients were admitted. I would try to review all of the patients admitted. I spent time every day teaching medical student (two from Malawi, one from Holland and one from Scotland). I would always take a break however brief for lunch and then return until 4 or 5 in the afternoon. Every day for an hour, at 7am, staff met for various activities; morning report, prayer, a presentation, chapel devotions. The chaplaincy program has expanded from one to four pastors and they offered comfort and encouragement when they visited the ward.

It was challenging when the electricity went out (which was a daily occurrence), the generator did not come on and children did not receive oxygen. At one point the generator broke down completely and had to be taken away for 5 days for repair. Praise God the electric company agreed not to cut the electricity during that time. The ultrasound and chest x-ray machines broke down. Without electricity we could not perform blood tests or surgery. Patients had to be driven an hour away to Lilongwe by ambulance for services we could not provide.

Children came to the hospital extremely ill, sometimes they died within minutes or hours of arrival. Despite the difficulties and perhaps becuase of them, I was filled with great joy as I served. It was a priviledge to be the hands and feet of the Great Physician, Jesus. Thank you all for supporting us. (You can check out more patients' stories at my blog http://missionmed.blogspot.com/ ).