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A letter from Barbara Nagy in Malawi                  

November 29, 2007

Dear Friends,

We are once again filled with delight at the coming of Advent and the celebration of Jesus’s birth. I pray that during this season a sense of wonder will surround you and protect you from some of the distractions of our culture—which overloads us with things—and that you will be filled with joy.

Nkhoma Hospital has been working to improve its maternal and neonatal health for the past few years, trying to combat a maternal death rate hundreds of times what it is in the developed world. So the vision of a baby born in a stable brings lots of things to mind. I only hope that in the excitement of angels and shepherds God glossed over a few things, like a trained birth attendant, good nutrition and antenatal care, and infection prevention measures.

Malawi recently placed 135 out of 136 (next to the poorest) in a survey of underdeveloped countries for the chance of a child being alive to enter fifth grade. As a pediatrician, I know the single most important advantage any child in a developing country can have is a healthy, living mother. She is not only the incubator for the unborn child, but the primary determinant of whether that child is well nourished, nurtured, likely to survive a whole host of childhood problems such as malaria or tuberculosis, whether that child will be abused or married off early to the wrong partner, or whether that child will ever make it to school.

Fortunately, there are many things that can help improve maternal outcomes. We have noticed that after two good harvests the birthweights of newborns at Nkhoma has risen significantly, reducing the risks of death due to infection, hypoglycemia, premature lung disease, and many other problems. Therefore, we hope to supplement mothers in antenatal clinic with high quality, vitamin enriched food, simultaneously improving health and nutrition and encouraging women to start early in their pregnancies with antenatal care, when it has the most probability of benefit.

All women are offered free HIV testing and medicines to prevent transmission of HIV to their babies during delivery, if appropriate. This has helped many women with HIV to be identified so they can start antiretroviral treatment themselves. A series of protocols for mothers and babies have significantly improved the outcomes of both, and are being disseminated to other hospitals in central Malawi.

Agreements between Nkhoma Hospital and the Malawi government have enabled us to offer free care to more high-risk mothers, and this has increased the percentage of women able to come to the hospital or a health center for delivery. However, there are still many who either can’t make it to the hospital in time, can’t afford care, or prefer to deliver at home using unskilled helpers. At present, this group comprises almost 50 percent of women delivering in our area, and the results can be terrible.

Lest the men reading this feel marginalized, several of our sister hospitals have tried inviting husbands to visit the maternity wards and giving families the option of having both partners in the delivery room. To do this at Nkhoma will require us to build a new maternity, which is also badly needed for space reasons, but we feel these are important interventions because they increase the percentage of women delivering using trained birth attendants.

I would appreciate people praying for the spirit and stamina of our staff, which is severely overworked. At its busiest times, the hospital can have 300 or 400 patients (as we do now, due to malaria) and there are usually just three nurses in the entire hospital at night to supervise numerous critically ill patients, attend to post-op care, and deliver babies. Last night we had four emergency caesarian sections, with the mothers and babies quite unstable afterwards, but all still with us the next morning. I rejoice that these are mothers and babies who probably would not have lived but for the services they found at Nkhoma.

We also appreciate the friends who have supported us throughout the year with money to buy medicines and provide charity care. Nkhoma’s doors would not be open were it not for your help.

Blessings to all,


The 2007 Mission Yearbook for Prayer & Study, p. 337


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