A Silent Emergency

Dear reader, greetings to you from Papua New Guinea on this Holy Week before Easter. We are half way through our time here at Kudjip Station and the Lord continues to fill our cup to overflowing every day with enriching experiences and relational opportunities. Among many challenges we face every day, there are those in which we find success (praise God!), those in which we fail to see fruit born but know the Lord is yet at work, and others lingering between the two extremes in which we desire to see impact for the Kingdom but do not yet know how to play a part. For my time working on the Pediatric Ward, the frequent admissions for severe malnutrition and consequential disease and death continues to spur my desire to help find a solution. 

Baby Setina Dominick admitted last week with marasmus (severe malnutrition)
being measured on the length board I made in 2015 when we lived at Kudjip for one year.
She died on the Pediatric Ward early this morning.

Malnutrition and growth stunting is so common here in PNG that it is almost normalized, and therefore marginalized, hence the reason it is a "silent emergency". The reality is that PNG is one of the most verdant and resource-rich countries in the world, but the vast majority of the population are subsistence farmers with limited opportunity for community development due to governmental corruption and their own dysfunctional tribal systems. This leaves a handful of very well connected nationals wealthy and healthy, while the rest of the population struggles to carve out their survival from the land. Furthermore, any interruptions in cash crop sales (coffee, cocoa, coconut, etc) from drought or tribal fights reduces access to protein food purchases (eggs, peanuts, canned tuna, etc).

Stuck in this extreme poverty, most PNG families have many children. The upside of more children is a stronger labor force for the family's subsistence farming, but it also means more mouths to feed. With an abundance of garden crops, older children have plenty to eat, but when children are born too close together, the older infant weaned from breastmilk is left to survive on starches and greens devoid of protein, and they become severely malnourished and susceptible to every disease. This same lack of breastmilk protein affects many young infants abandoned to relatives due to the mother re-marrying or dying of diseases like HIV. Most adoptive caregivers can’t afford expensive formula and instead use fake milk products widely sold in local stores (Milo, Indomilk, etc), none of which supply the protein nutrition needed to grow and survive. The first 1000 days of life for a child makes or breaks their health and growth for a lifetime.

Baby Andy Boi, admitted a month ago with kwashiorkor (another form of severe malnutrition), developed a very bad infection and DIC (causing the bruising you see on his abdomen). With just the right meds, supplemental nutrition, and prayer, he is well on his way to being healthy again and was discharged from the Peds ward this morning. 

I recognize most of you reading this have not witnessed the harsh realities of the developing world, so to bring this all into perspective here are the sobering statistics:

Papua New Guinea:

• 1 of 13 children under age 5 die of malnutrition complications (~33% of all hospital deaths)
• 50% of children stunted (4^th highest in the World)
• 24% underweight
• 14% Moderate-Severe Wasting (SAM)
• Generational cycle of poor growth/learning and low income potential

Worldwide (mostly from South Asia & sub-Saharan Africa):

• 47 million children under age 5 with Moderate-Severe Wasting
• 149 million children under 5 with Stunting
• Malnutrition accounts for 45% of Deaths under age 5 (1/3 of the total 6.3 million annual deaths for children under 5 years old)
• 1 in 3 children worldwide affected by malnutrition

On Sunday, I helped give a medical Tok Save to the community after we attended a local "bush church". We discussed the recent case of Measles in PNG, healthy nutrition for the children, preventing the spread of germs, and how spacing pregnancies can prevent malnutrition.

With most of the factors contributing to pediatric malnutrition well out of our control here in PNG, I have started having conversations with hospital leaders about what changes we can make now to make a difference. Some of these include:

• Reducing exposure of admitted malnourished children to other sick children on the ward by moving them all to one end of the ward and creating a barrier to separate them (in future perhaps building a separate malnutrition ward)
• Improving caregiver education while they are admitted on the ward - scheduled "Tok Save" sessions with maybe some new picture charts for easy understanding of healthy milk/foods, what junk foods/milks to avoid, and simple measures like boiling water to reduce disease
• Augmenting the hand-off of discharged children to the primary health clinic, to ensure optimal follow-up and ongoing supply of "RUTF" (Ready-to-Use Therapeutic Food, complete nutrition peanut butter packets)

In addition to these, I plan to facilitate in the next couple weeks an in-service for hospital staff to review our protocol for the admission and care of malnourished children, while also taking the opportunity to rally their interest in making a difference in our communities by spreading the word on methods for preventing malnutrition. 

Meeting with leaders of the Pediatric Ward and outpatient Primary Care to discuss ideas for improving outcomes for our malnourished children. 

Please join us in praying for these endeavors - for the Lord to open doors to impact change in our care of malnourished kids, for the Kudjip hospital staff to become united in mission to educate the community, and for the leadership of Papua New Guinea - the governmental officials and policies which might some day meet the needs of their people.

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HOLY WEEK TUESDAY

“Therefore keep watch, because you do not know on what day your Lord will come. But understand this: If the owner of the house had known at what time of night the thief was coming, he would have kept watch and would not have let his house be broken into. So you also must be ready, because the Son of Man will come at an hour when you do not expect him.”

Matthew 24:42-44

With the ER staff, sending love to our church family back home at WEAG. Thank you all for your encouragement, prayer warrior power, and financial support!