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.”
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