53: Overseas Project #8, Malawi, Day 3

The adjacent Presbyterian church (Dutch Presbyterians founded the hospital, church, nursing school and theological seminary) has an 8:00 English service and a 10:00 Chichewan service.  English is the nation's official language, well-spoken by the educated, but most of the hospital's patients speak only the local Chichewa.  My camera caught a visiting choir.  Many mornings we were awaken by distant sounds of practicing choirs, and when the electricity was down at night, we again heard choirs.

The hospital struggles to stay solvent. Monthly hospital income: $31,000 patient fees (I have no idea where they get hard currency), $50,000 from the government for salaries, and about $15,000 donations, for a total of $96,000.  Expenses: $16,500 medications and supplies, $75,000 staff salaries, $7,300 maintenance, and $10,000 administrative costs, for a total of $109,000.  The government owes $24,000 based on prior agreements for capitated ob and peds, but that would cover just two months of the projected $12,000 monthly deficit.

By contrast my local hospital, St Joseph, has about the same bed capacity, but a billion dollar annual budget--that's over 83 million dollars a month.

52: Overseas Project #8, Malawi, Days 1-2

Two red-eyes dissected by a 9-hr layover in Healthrow pretty much destroys my credibility as a travel agent, but about 45 hours after leaving Seattle we did arrive at Nkhoma, Malawi for overseas project #8.

With a bed capacity of 200, Nkhoma Hospital and its 10 satellite clinics serves an area of about 30,000  subsistence farmers. Patients are on their own for food, bed linen, even IV fluids. Our anesthetist expressed concerns about postoperative patients being underhydrated (adequate hydration is a critical postop issue) because patients can't afford IV fluids.  But nursing neglect provides a better answer--no one walks around adding up supply costs for subsequent hospital bills.

For fourteen years Rainier Te Haal, a South African by birth but Dutch by heritage, temperament, and marriage, has been the hospital medical director. He is an all-purpose general surgeon and also takes call for anesthesia, providing spinals for cesarean deliveries. He has developed a specialty in vesicle-vaginal fistula repair, teaching the technique to Malawian colleagues. Rainier and Wilika have six children; the oldest son is in a boarding school in Nairobi, followed by three daughters and then two younger sons, both local adoptions. Four years ago he spent a Sabbatical in rural British Columbia and was tempted to stay, but “they need me here.”