We're sorry for such a long delay in writing but maybe volume will make up for frequency!

The big new from us is that all of the Christian hospitals in Malawi were closed for two weeks to more than one month August and September since the government had not paid salaries for several months. They had also put in their budget, after changing the fiscal year from April to July, that they would pay less than 65% of salaries when they do pay salaries. The northern hospitals (which we're one of) closed first then the central and southern CHAM (Christian health Association of Malawi) hospitals joined us. What a terrible decision but how can we ask staff to work without compensation for an unknown period of time? How can we spend donor money on salaries when that was not the purpose of the money and sustainability would be sacrificed? Anyway, prayers were answered and Government finally agreed to meet CHAM representatives and has come up with some of the money and promises the remaining amount.

So, now the hospitals are open again and here at Embangweni female ward and maternity is past capacity (meaning we're back to patients sleeping on the floors) and children's ward is filling up again (three children on one bed, each one getting a blood transfusion). We are seeing more and more orphans here and in fact have admitted four this week alone. The stories are usually similar: mothers die of long illness (AIDS) or maternal complications (often, but not always, home deliveries) and too often the father may have already died during the pregnancy or shortly before the mother does. Then it is the female grandmother/aunt to care for the child and she often has other children which may or may not be her own to care for. I'm sure you know how the extended family situation works. What makes it so complicated here is how best to feed the child and assist the families. I feel comfortable with what we do but don't know how folks in developed countries would feel about our policies. If the child is less than two, and the orphans that come to use are from one day old to one year old, then we always encourage and try to stimulate the breast feeding by the aunt or grandmother. We do this by giving them medication which helps stimulate milk production and supporting them giving the baby the breast. We also encourage the child to suckle by using a "breast supplementer." This is a small nasogastric tube with the tip held at the nipple by the guardian and the other end placed in a cup of milk. When the child suckles it sucks the milk up the tube but it thinks the milk is coming from the breast so is not frustrated by sucking on a dry breast. I his also stimulates milk production and in fact is more important than the medication. We do not give formula or powdered milk. Depending on the age of the child we use either diluted goats milk or soya milk which the guardians are taught to make so they can continue when they get home. We only keep the orphans long enough to make sure they are healthy or treat any illness they may have, to see if the guardian's milk will come in okay, and to teach the guardians how to best feed the child. It really is pretty amazing how well some of the orphans are doing.

We are needing to expand our goat project now and are planning on giving a hybrid milk goat to the guardians of the orphans to take home with them when they are discharged. They can then breed the goat and give us the offspring in exchange. We have one exotic male milk goat which we have bred with several local females to increase the milk production of the their offspring and that is the milk we use for the hospitalized orphans. To increase the project we will need to build another local corral to separate the offspring from the father (don't want too much inbreeding) and eventually we will buy another exotic male goat from the agriculture college in southern Malawi.

Male ward is still slow which is a blessing because we are very short staffed (3-4 people/ward instead of the minimal 5) and people are having to cover two wards and work 6 - 8 days in a row.

As always we do crisis management and another crisis is the Matron (nurse in charge of all nurses, medical orderlies, and ward maids), Julia Nyirongo (one of the two Malawian registered nurses) has submitted her resignation and will leave the end of December. Some good news however is that Judith Banda, who was matron and is a trained psychiatric nurse, has now been freed from ward duties two days a week to conduct psychiatric clinic days on Tuesdays and Thursdays. She has also been accepted to attend a "mental health in developing countries" workshop in London for four days in December and except for incidentals she was given a bourse for the course. The sad part for her though is her niece was admitted to the hospital last week but has been discharged so she can die comfortably at home. Please pray for her and her family and pray that either Julia decides not to leave or we are blessed with a Matron soon. It had taken us about five years to finally get a Malawian registered nurse to come here!

During the hospital shut down I was actually hoping for some time to catch up on some things but my office did not get any time off during the closure. We could not do any out reach or static clinics so we used the time, with the help of several staff members, to train all of the hospital staff, including groundsmen, administrative staff, ward maids, nurses, etc., in exclusive breast feeding. We're trying to become a "baby friendly" hospital which requires lots of work for staff and the community. Only 11 hospitals in the States are called "Baby Friendly" and yet six are in Malawi. It basically means that the hospital supports breast feeding only in the first 4-6 months of life and will not encourage or use baby formulas except for medical reasons. We're trying for March next year and will see what happens. Not only does all the staff have to be trained (18 hours for nursing staff) we have to establish 21 breast-feeding support groups (250 people) in the communities. By the end of this month we will have trained almost everyone. They seem to be really interested in the information which may because it is such an integral part of every day yet people know so little on how breast feeding all works.

We're also continuing with a mosquito net project and have purchased nets from South Africa and gotten some from UNICEF. We're training seven communities to do their own book keeping and dipping so they can manage the project on their own. Hope it goes okay. Don't quite know what we will do if they steal the nets or something.

A few months ago I met a woman who is working in the southern part of Malawi at a place called Zomba from the Presbyterian Church, Ireland and was here visiting the Irish missionaries. She is working at an agriculture training farm and they conduct one week training program on composting, crop rotation, deep digging, etc. It is geared for local farmers with lots of practical experience and also includes small animal projects. So, we organized for one gardener and one home craft worker from the hospital to attend one week of training. Hard to imagine being excited about manure and compost but they were and have been "spreading the word" so to speak every chance they get. This really is a blessing and will be a big help if the message is taken to heart by the subsistence farmers since with the devaluation they will not be able to buy fertilizer for their maize. Not that maize is what they need to focus on growing but as they say here, "if you haven't eaten nsima (maize), you haven't eaten."

Another activity of the primary health care department was a survey to elicit people's views on family planning and using community-based distribution of contraceptive agents (CBDA). We got lots of interesting and useful data which will affect our family planning program.

On the staff side of things, we have a wonderful medical assistant named Hankie Mkandawire who has had esophageal cancer for over a year and has undergone some very drastic surgeries here to help palliatively. He and his pregnant wife are back from Dar es Salaam where they had gone for palliative treatment at a cancer hospital. Dr. Oldham, who is a cardiothoracic surgeon at Duke University and has been to Embangweni several times to donate his surgical skills, has connections with a doctor at that hospital. When Hankie left, he said if he died there to throw his body into the Indian Ocean which is a really non-Malawian thing to say. We had been told the treatment would be free, he just needed money for transport and etc. which we all helped him with. Well, that information was completely wrong. The treatment is not free for foreign patients. It cost US$ 800. Hanky had left with only (!) US$ 600. Well, when he got to Dar the hospital reduced his charges to $300 and plus gave him and his wife 50,000 TSH!!! Anyway they had a good, fairly uneventful trip and he received something like 10 radiation treatments and was told that he has to wait two months before anyone can tell if it has helped or not.

We don't know if you keep up with the financial problems of the world but did you hear about the devaluations in South Africa, Zimbabwe, Malawi, etc. The Malawi kwacha devalued two or three times over one week and it is now at K 46.00/$ 1.00 from K 26.00. This will make life even more difficult for villagers. Prices are going very high.

Jim was just in South Africa on September 28 to drive a new car up with some folks that we know and who finance and help do the shallow well work. On his return he regaled us with stories of all the great food he had eaten along the way. I was at least hoping for at least one or two stories of great hardships but they did not materialize.

Now to the kid news. The boys are real toddlers now and moving all over the place. Our house is one point of a triangle with the Storniolos' house and the Kennedy's house on the other points (other missionaries here). Well, if we leave the boys outside in front of our house to play without us for a minute or two we find them on the path to both houses, Michael in one direction and Jason in another! The boys still have no real words but lots of gibberish and sounds that might be "car" and "bye-bye." They are able to do some sign language that we are teaching them and can sign for "all done," "more," "please," and "thank you." Michael seems to be the engineer-ish one and Jason the football player, but both like to listen to books, they make great faces, and have great laughter. They are beginning to feed themselves with spoons/forks which is definitely one of life's mixed blessings and they are just being lots of fun. They also have several teeth which come in at the same times and the same locations. Twins are interesting that way.

The personal sad news is my dad died June 9. I received news that he was seriously ill via radio communication on Saturday evening, June 6 and was able to make the BA flight out on Sunday. Nancy Dimmock, a PCUSA missionary in Lilongwe (it is she and her husband Frank's e-mail (and their five kids) that we usually use), made a reservation for me and with a few hassles, like British Air not being able to issue a ticket from the airport on Sundays because they are locked in the safe in the city, (I traveled home with a boarding pass and a handwritten note from the BA personnel in LLW), I made it to Chicago Monday afternoon. I was able to visit her father twice in ICU Monday, once in the afternoon and once again in the evening. Both times he knew me and we were able to communicate some. He had cardiac failure with kidney failure and was totally swollen. He had gotten some dialysis but it was clear that this was not going to be reversible. When I arrived at the hospital 8:30 a.m. Tuesday I was able to be with him until he died at 9:15 that same morning. It was a beautiful, though painful, experience and I felt like I was able to escort him as far as humanly possible into his next phase of existence. The experience really taught me that God's timing is to be trusted. Not always understood but certainly to be trusted. Now, if we can just remember that!!!

Jim is heavily involved in an active and exciting shallow well program, in building primary schools and churches, and hospital maintenance. Since this letter is way too long now and we'll need something to talk about next time, we'll save those projects for next time.

God's blessings to you and the Second Presbyterian Church from us and the Embangweni Church.

Jodi, Jim, Michael, and Jason McGill

We're so glad that you sent your letter twice because we have only received one copy and that was yesterday. Thank you so much for your prayers. At morning chapel we have recently been focusing on prayer and the privilege and responsibility to pray for those that we know and that we don't know. It can sometimes be difficult to feel that we are praying effectively for people we don't know since we don't know what they be facing. In fact, my (Jodi) chapel topic this past week sort of addressed this and included the following passages: Philippians 1:9-11, Ephesians 1:16-19, and Colossians 1:9-11. So, we really do appreciate knowing that there are people whom we have never met who are praying for us and others in the world. It also reminds us to do the same!

Thanks for all the information about yourselves. You both sound like folks that we would have a lot in common with and when we return home we would love to meet you and the congregation. It is great to hear the outreach work which your church is doing in the community. We have found that a church who is active in local outreach ministries becomes involved in foreign mission as well and visa versa. It seems like being involved with people outside of the church community alone can become addicting.

Regarding e-mail. You are correct that there is no e-mail at Embangweni but there is an e-mail connection for urgent communications through Nancy and Frank Dimmock in the capital, Lilongwe. Part of their work is to help us and other missionaries in the country with communication. Their e-mail address is: Fdimmock@eo.wn.apc.org but it really isn't for daily communications. When the Dimmocks get a communication they then radio us on a twice-a-day schedule or send a hard copy up with someone coming back to Embangweni which is about two to three times per month. Anyway, although the mail system is slow it is mostly reliable and the preferred method of general communication. If your church were to decide to make a mission trip visit to Embangweni then we could certainly use the e-mail to finalize details, etc.

Pen pal exchange would be a fine if someone with experience on the States end could educate those that receive the letters about the expression, "To ask is not to steal." We are always hesitant to hook up pen pals because although we asked folks here not to make their letters a continuous "wish-list" the letters still sometimes turn out that way. One of our sister hospitals also has a nursing school so perhaps an exchange would also work with them. We'll forward this information on the them. The hospital is Ekwendeni Hospital.

We don't want to sound like a travel book or anything but just to give folks a general idea of Malawi and where we live we'll describe a bit about both. Embangweni is located in north western Malawi, about 30 km from the Zambian border. We are under the Synod of Livingstonia which is one Synod within the Church of Central Africa Presbyterian. Embangweni is in Loudon Presbytery. The mission station is composed of a church, the hospital, a secondary school, primary school, and school for deaf children. The hospital serves about 90,000 people with currently three doctors but that will go down to two when Becky Loomis leaves in June. The hospital has 120 beds and nearly at least or greater than 100% occupancy all year around. It has four wards; pediatrics which is for children <= 6 years of age, female ward (medical and surgical mixed), male ward, and maternity. We also have a nutrition rehabilitation unit for malnourished children. The church has a congregation of nearly 3,000 people. It split into two congregations two years ago because the congregation was too large. The Loudon Presbytery was left with about 2000 members and the new church at Kamsolo had 1500 members. Now both churches have 3000 members. There is one minister for each church, no assistant pastor or youth pastor. The minister visits a prayer house each month by bicycle so that communion can be given. The churches rely heavily on women and men elders to preach, teach, and carry on church activities.

Malawi itself is land locked and surrounded by Tanzania to the north, Zambia to the west, and Mozambique to the east and south. The population is an estimated 11 million people and nearly 50 % are less than 15 years of age. The major exports for cash are tobacco, tea, and cotton. The annual yearly income per person is about $150.00. The life expectancy is about 40 years of age which is influenced by a high childhood mortality rate and a high prevalence of AIDS. 95 to 98 % of Malawians have general knowledge about AIDS although some still continue to have misconceptions regarding transmission. For the past several years Malawi has been consistently ranked among the five countries with highest prevalence of AIDS. One factor influencing the HIV transmission in our area is the practice of polygyny (one husband, more than one wife): 28 % of women in the Northern Region are in a polygynous marriage, of those 60 % have one co-wife. Polygyny is practiced in all of Malawi but it is more common in the Northern Region. The maternal mortality rate in Malawi is 620 deaths/100,000 live births (compared to 8 deaths/100,000 live births in the USA, which is actually a higher rate than that found in several European countries) and about 45 % of women deliver at home with 70 % of them being delivered by themselves or untrained family members. 1 in 4 children do not live to see their fifth birthday and Malawi has the highest level of infant mortality for 11 countries of Eastern and Southern Africa; about 60 % of deaths occur in < 1 year olds. The causes of infant mortality are malaria, anemia, pneumonia, malnutrition, TB, and AIDS. 1/10 children 12 - 35 months of age are severely undernourished and over 25 % of all children in Malawi (<5 years of age) are underweight (stunted, wasted, or both). In rural Malawi 1 % of women and 4 % of men have reached secondary school although the Northern region fairs better in education than other regions. Malawi actually has a better immunization rate than the USA, nationwide 82 % of children in Malawi have been fully vaccinated against TB, Measles, Polio, Diphtheria, and Tetanus.

So, what are we doing about any of these problems. Sometimes it seems like not much when four children in the hospital die in a weekend from malaria and pneumonia and TB. But, along side our Malawian counterparts and with God's strength, we are still trying.

After working in the wards and as nursing supervisor and doing many other activities for several years, Jodi, who is a Family Nurse Practitioner and has a MPH in Health Education, works almost full-time in PHC now. She still takes night call twice/week to help out the medical assistants but no other clinical work, usually. One of the activities of PHC is to supervise and assist the nutritional rehabilitation unit for children who have been admitted due to malnutrition. We raise rabbits for meat, goats for meat and milk, ducks for eggs and meat and have a dry season and rainy season garden. (Different crops are planted in different locations depending on the season.) So far this year we have eaten two rabbits and a goat. Three female goats have recently delivered so we are getting between 1000 ml and 1500 ml of goat milk/day. The milk goes to the most malnourished child at NRU and they really love it. Goats are commonly raised in our area but primarily for cash, they sell them for meat. The purpose of our goat project is to show women that their children will drink goats milk, that goats are a good source of milk not just cows since not as many people have cows, and to get the mothers habituated to using goats milk so that hopefully they will continue to offer it to their children when they get home.

A new activity for the NRU was a cooking contest for the women of the malnourished kids at NRU which was fun for them and for the judges. The women were judged on taste, originality, and how they explained the "nutritional whys" of what they cooked. We are some very original recipes like combining the leaves of locally grown wild greens with soya flour (which the women ground themselves from dried soya beans), "tea" made from roasted soya beans and served with soya milk they made themselves, pumpkin with ground peanuts, and several other dishes. It was great fun. The three winners were given a bar of soap, a baby wrapper and a small tin cooking pot, and the others received a wrapper and a bar of soap for participating.

We're working on becoming a "baby-friendly hospital" which is a program sponsored by WHO/UNICEF to promote exclusive breast feeding. Although basically all women breast feed, there is a cultural belief here that "bara" (a thin, maize porridge made with water and maize which has had its nutritious external kernel been beaten off) should be given to babies as early as one month of age. This often leads to malnutrition and can lead to early pregnancies because if a woman exclusively breast feeds she is protected for the first five to six months from getting pregnant. An early pregnancy can also threaten the young child's nutritional status because it is also a belief here that a pregnant woman should not breast feed which means that a young child will be weaned much too early. We had a visitor, Kit Sluder, who did a good job of looking through all of the materials and is putting together along with a training schedule. She has even made a model of a breast out of a piece of knitted stuff she found. We were joking with her that she has been the most dedicated volunteer we have ever had. No one else has left their breast, or any body part, behind before! Maybe their blood since we always get a donation before people leave but not a body part.

We have trained several people in AIDS counseling from the local AIDS committee. We are very fortunate to have a Malawian nurse with training in psychiatry and she is working with a psychiatrist from St. John's of God in Mzuzu to establish a monthly mental health clinic and to train community health workers on identification and treatment possibilities of mental illnesses.

We did a survey for three days, one day at three different villages, to determine how folks felt about having community-based distribution of contraceptions and general family planning usage and unmet need. We surveyed a total of 190 people (women 15 - 49, men 20 - 54, and female gogos) in the three sites stratified according to the expected population in each site per the demographic health survey, 1992. As always there were glitches but I think most of the data will be fine. (One of the younger interviewers thought that three women who were 35 - 40 years old were "gogos", Chitumbuku for older people or grandparent! Based on the information, we have trained 30 women and men in community-based distribution of contraceptives and plan to train more next year.

We're doing some training of village folks to create a Hospital Health Committee and we have a bed net project to address malaria. Folks really seem to want them even thought they have to pay for them.

We conduct health fairs in outlying areas which address giving blood, acceptance of insertion of nasal gastric tubes, making protein-enriched porridge and local oral rehydration salts, blood pressure checks, and other topics based on the community.

Jodi, with the help of Frank Dimmock (PCUSA), Mark Young and Richard Kerr (PC-Ireland) is organizing for 25 PHC and /or AIDS coordinators from CHAM hospitals throughout Malawi, a health leadership and training-for-transformation workshop - thanks to funding from PCUSA. Please pray for it to go well. It is going to be from June 8 to July 3. Jodi is getting very nervous about it so please pray for the organization of the workshop, the facilitators, and the participants.

Jim's parents were Presbyterian missionaries to Zaire, so he grew up between the rural interior of Zaire and boarding school in the capital, Kinshasa. He graduated with a B.S. in Physics from Wake Forest University in 1981, then worked in the oil fields in Texas until joining the Department of Geology at Duke University in the fall of 1982. He worked for them for five years doing geophysical research on several of the East African Great Lakes. After marrying and moving to Tucson, he finished a MS in Geological Engineering. Since completing the degree, Jim has primarily been doing development work at Embangweni, but does continue to do geophysical research, mostly in the African Great Lake Region.

Jim's duties can be listed under the umbrella title of Development. This includes developing and overseeing progress of the Shallow Well Project, in which responsibility for clean water is turned over to the villages. The project manufactures water pumps locally and trains local staff in the maintenance and repair of all pumps. This has empowered the people to be able to know that they can do something about clean water themselves, without having to rely on outside sources. Development also includes working with the World Food Program in Food for Work projects which built roads and bridges to facilitate transport to remote villages and health facilities. Development is also working with "Self-help" building projects including schools, churches, and health centers, assisting in design, construction, and purchasing materials. He has organized through self-help the building of three churches and two primary schools. Self-help means that people contribute what they have which in this society, and many others through out the world, means time and labor. People hand make and burn their own bricks, break large stones into gravel using hand hammers, carry water to mix cement, etc. Jim is also responsible in overseeing maintenance for the hospital, its vehicles, and the mission station's facilities.

In 1995, Jim designed and was responsible for the building of the only school for deaf children in northern Malawi. The funding primarily came initially from Marion Medical mission, Marion, IL but now Jim is getting grants from other sources. Malawi has only 3 schools for deaf children in the country and the other two schools are in the central and south.

Michael and Jason, our twin boys, are doing wonderful and gifted things! They each have two teeth in the bottom of their mouths. Michael got his first tooth the day before Easter and Jason got his the next week. Then Jason got his second tooth and Michael got his later. They are both crawling all over the house and beginning to "cruise" on the furniture or whatever seems to be available; our cat, us, visitors, etc. Laston (the cook) and Anya Shaba (their nanny) are both super with the kids and Florence (Anya Shaba's baby girl) are all playing together. The neighborhood boys come by to see what toys Jason and Michael have and to keep them company. The boys are constantly being spoken to in Chitumbuku so I'm curious to see what their first words will be. The boys were baptized at the church at Embangweni February 15. There were people from all over the world there to promise to help us raise us the boys. We did keep a record of all who came so that we could take them up on those promises when we need babysitters!

Jim does know the Hulls very well and probably the French teacher you were mentioning. We'll send along some pictures with the letter which is being carried to the States with a visitor. I'm also including a projects list that is obviously a "form letter" but it does give you ideas of all the different options for helping out. It is only a list of ideas, it can be modified by you.

Thank you again for your wonderful letter and your church's support. We also thank you for your comment about being satisfied with short letters because that is usually all we are able to manage! However, we thought the first one should give you some information about the place, the people, the problems, and us. Hopefully it has not been too boring.

Blessings,

Jodi, Jim, Michael, and Jason