Wednesday, February 26, 2014

Blessings Hospital and Malawi's Economic Tsunami

Economics, the course I found most difficult to comprehend in my studies at Harding University, is having a devastating impact on Blessings Hospital. But, there are some pretty simple economic truths that did make sense and stick with me until this day, most of which my Daddy taught me before I got to Harding.

  1. You can’t spend money you don’t have.
  2. Loans cost more than savings earn (bankers have to make a living too).
  3. When the government prints more money, it is relatively worth less.
And now, a brief summary of the economic chaos which is Malawi today.  For some years Malawi has been very dependent on outside donors for the normal operations of government, not just special projects.  Forty percent of normal budgetary operating expenses are paid for by outside donors, with England leading the way.  In August or September, while the president was out of the country, a high-ranking budgetary official was shot in the face about midnight one night as he was waiting for the gate to his house to be opened.  Other high-ranking officials were accused of being involved in this attempted murder.  

Shortly after this a series of low and high-ranking officials were found to be in possession of rather large amounts of cash, extravagant houses, or other things far above their means  for which they could not account. Now, after some weeks of international forensic auditing, it has been announced that $34,000,000 either disappeared (half of it) or was grossly misused by government officials in the six months ending in the shooting.  England and the European Union cut off all aid to the country in anticipation of this result, gutting that 40% of the country’s operating budget.  

The value of the Malawian currency, the Kwacha, has plummeted, going from a fixed rate of 150 per dollar to a depth of 430 per dollar in less than 2 years.  The troops in the trenches were pressed as salaries decreased in buying power.  Some non-governmental international aid organizations (NGO’s) were able to make salary adjustments to the extent their income was in dollars, but government no longer had such a luxury.  Even the cost of corn soared as the fuel to transport it and grind it climbed in price. Workers became very restless.  Something had to be done.  So, the government gave all its employees a 50% raise.  

This eased the cries of the proletariat, but . . . where did the money come from?  Within a few months reports began to leak out.  A friend working in a government clinic told me that at their site, the only medicines which are available are contraceptives, malaria medicine, and meds for HIV, all of which are supplied through special projects mostly administered through NGO’s without the government touching the money.  Other departments reported workers sitting in their offices unable to do their usual work due to no tools or ability to take a departmental truck into the field.  The one department that seems to have increased activity is the Malawi Police Force:  I have never seen so many police on the highway handing out fines newly increased from MK 3000 to MK 5000.

The effect on competition for workers with the private sector has been devastating.  Due to chronic shortages, the government and mission hospitals have not quit hiring medical personnel.   Mission hospitals (called CHAM hospitals for their membership in the Christian Health Association of Malawi) have been relatively protected because their clinical personnel are paid mostly by the government.  One large mission provider recently reported that 40% of its income comes from the Malawi government, 40% from donations from outside the country, and 20% is generated from church contributions within the country and from hospital revenues.    

Blessings Hospital is in trouble.  We are running out of nurses, and are unable to hire others at our current salary level.  The administration is working hard to become a CHAM member, but it is estimated that the process will take 2 years.  Most of our operating revenue comes from the care we deliver.  Our census is rising.  The number of people we are helping is going up.  The number of babies born in our facility is increasing.  By the grace of the Sara Walker Foundation we are visiting an increasing number of villages with a mobile clinic, villages that are far from medical care whose only transportation is a bicycle.  The same vehicle makes it possible for us to carry patients who need it to a higher level of care. 

Our biggest acute problem is personnel salaries.  We need to give our workers a generous raise.  We need to hire others.  Desperately.  We are living off per diem nurses who earn less, mostly government workers who are willing to double on their vacation days.  But, the time when most people take vacation is about gone, and our needs are increasing as our nurses leave.  

If you would help us raise a nurse’s salary up to a minimum level, or even explore a partnership like that for one or two years as we process our CHAM papers, please contact me at  We will be happy to share further details with you and explain how to process your tax-deductible contribution so that it can be used most effectively.  Learn more about Blessings Hospital through her Facebook page, or for a tour of the hospital, click here.

Friday, February 21, 2014

Ox-Cart Medicine

For some time the staff at Blessings Hospital have longed for the security of an ambulance with dedicated driver to provide a means to transfer complicated patients to higher levels of care.  This prayer was answered in January by the Sarah Walker Foundation with the equipping of a used Land-Rover Defender (the famous, nose-down box that never quits) and the hiring of a driver.  This vehicle does many duties, one of which is to carry a clinician to outlying villages within our service area, where local churches offer their building as a clinic site, and then work with the chief and their neighbors to spread the word insuring that patients come.

Yesterday the clinic was at Chimbwala, some 20 km /15 minutes away.  It was afternoon.  The clinic was finished and the driver and clinician were packing up their supplies to return when an ox-cart was noticed  moving unusually slowly toward the church building, but there were no oxen!  Instead people were struggling, 4 pushing the yoke and 6 pushing from behind, to move the cart along.  In the cart was a young man who was seizing.

The patient had complained the day before of body aches and fever, but people had ignored him.  He wasn’t much better when he woke up the following morning, and in the afternoon he stayed home while everyone else went to a soccer game with a rival school.  When his family and friends returned he was unconscious and seizing intermittently.

Lacking IV supplies, the decision was made to hastily move the patient to Blessings.  Not too long later Harold Banda, our administrator (himself a nurse-midwife), and William Banda, our nurse on duty at the time, were chatting on the front veranda when they noticed the ambulance careening around the corner into the hospital grounds, lights on, flashers blinking.  (We don’t yet have a siren or true emergency lights on the ambulance, and they were sorely missed as the driver worked his way down Malawi’s principle artery in the late afternoon traffic which was returning to the capital).

William started back into the hospital thinking it was a ruse, but Harold urged him to wait and see: maybe there really was an emergency.  The staff on board hopped out of  the ambulance almost before stopping and related the essentials.  As they opened the back door to extract the gurney, the patient was seizing.  He had not regained consciousness since they first saw him.  The patient’s wife and friends shared the history, and  malaria, the most common illness in Malawi and one of the major killers, was immediately suspected.

Harold (who doesn’t regularly work clinical shifts) joined William in getting an IV started.  Some blood was sent to the lab for malaria testing, and IV Valium was pushed to stop the seizure.  Ceftriaxone was pushed as per Malawian protocol in case of bacterial meningitis, and then the malaria rapid test result returned:  Positive for malaria antigen.  IV quinine was begun, and the patient later awakened.  

The following morning a man walked into the hospital entrance, and he and Harold recognized each other immediately:  He was Harold’s head teacher in secondary school.  Questioning the occasion, Harold was
The "Man in the Oxcart"
thanking Dr. Harry.
told by the visitor that the malaria patient himself, also a teacher in the village where the clinic was held, was his younger brother.  The patient felt much better that morning, was awake and taking food and oral medicines, and was discharged with his wife and brother to finish a three day course of oral meds for malaria at home.  As is customary here where transportation is often a barrier to care, he was returned to his home in the ambulance.  

Medicine, perhaps especially in Malawi, at times presents occasions of great grief, futility and frustration.  Malaria can be stamped out, as it has in many countries, if the political will exists at national and local levels, and if enough resources are applied to the task.  South of the United States, for example, in two very different countries politically, Costa Rica and Cuba have eliminated the scourge, but they are the only ones.  In spite of the many frustrations here in Malawi, there are thankfully also occasions where all hands, including the neighbors,  do their parts well, everything works like it is supposed to, and potentially tragic or fatal situations are redeemed to life, joy, and ongoing service.