Using Community Strengths

A letter from Barbara Nagy serving in Malawi

March 2015

Dear friends,

One moving situation on the pediatrics ward occurs when all the patients’ families file out and walk to the hospital gates beside the family of a child who has died.  We had a similar but happy gathering last week when Sabina, a little 9-month-old girl went home.  She suffered a nearly fatal pneumonia as a young infant, which severely damaged her lungs.  Sabina couldn’t survive off oxygen, her home had no electricity, and we wouldn’t have had an oxygen concentrator to send home with her, so she remained in the hospital for nine long months, watching many others get well.  Her mom is an example of servant love, as she never left her side and remained cheerful throughout her long ordeal, often helping the other patients—and then there was a parade of victory as she departed.  It is hard to now enter the pediatrics ward without seeing Sabina’s smiling face, but she and her mom are doing well at home where they belong, and we expect Sabina will grow into a fine young lady in the years to come.

Sabina and her mother

We also were able to experience one of the great challenges of pediatric care today as we met a woman who is the mother of 12, of whom 6 have died.  Her 3-week-old baby was delivered in a field after a pregnancy during which the mother received no prenatal care because she belongs to a religion that does not accept medical interventions.  None of her children have ever had a vaccination, used a mosquito net, or benefited from any nutritional guidance. Her neighbors urged this mother to bring the baby to the hospital, where her life is hanging by a thread.  Could there be a more urgent call to address problems at a basic or root level? My work for many years has centered around care of acutely ill hospitalized children and education of nurses and clinicians to try to improve pediatric care in Malawi, which is often fatally deficient.  But after several years of contemplating the best use of my skills and calling, I realized that we needed to expend more effort trying to prevent diseases and create healthier communities, which has to happen at the community level.

With the help of many of you in the PC(USA), we at Nkhoma are trying to focus on root causes of poverty.  We are expanding a process called Asset Mapping, in which communities are guided to identify their assets and apply them to things they want to change, often health issues.  Assets can be people, buildings or resources, skills, location, etc. It is amazing to see what even very impoverished communities can do to move toward health, and they are also empowered to influence efforts of the health system and outside development workers to their maximal benefit.

In one of our health centers where this process has been ongoing for two years, every community health worker has been trained to deliver basic treatment at the village level for the three major killers of children: malaria, pneumonia and diarrhea.  We are hoping to add a module whereby these same workers will go out to check up on newborn babies to try to lower the very high rates of death in children below 1 month of age and also to start screening for chronic diseases like high blood pressure and diabetes.

This community, with help from donors, is building four outlying health posts so that services are constantly available close to people’s villages.  Also pit latrines, kitchen gardens and livestock are seen in most homes now.  One community has even opened a milk processing facility.  An emphasis on community strengths changes them from places of degrading passive dependence on others to places of hope and transformation.  People feel free to attack their community problems together and petition government or others for things that are outside the capacity of their communities: roads, bridges, irrigation, boreholes, schools, health facilities, etc. As more communities experience transformation the effect is magnified, because they can advocate as groups for basic needs.

Please pray for the success of community development at Nkhoma and throughout Presbyterian mission partner sites.  Because prevention seems less urgent than cure, in areas of severe resource limitation it is hard to carve out the needed support and prioritize primary health care.  We would also appreciate your continued support of our ministry in Malawi and the work of Nkhoma Hospital.

Blessings and thanks,
Barbara Nagy for all of the Nkhoma community

The 2015 Presbyterian Mission Yearbook for Prayer & Study, p. 156