By Timothy R. Gobble ’12 and Wilson G. Thomas ’13
Faith Banda was 34 years old when she became pregnant with her second child. She went to the small, rural clinic in her village in Malawi, Africa, when her labor began. Her blood pressure was found to be elevated, and she was referred to a larger hospital where she received one antihypertensive drug, and subsequently delivered a baby girl successfully.
That was four weeks before she came to Malamulo Adventist Hospital (MAH). She’d since become severely short of breath, unable to walk or lie down. She had gone to another clinic when the symptoms began and was given an oral diuretic. However, her symptoms worsened, prompting her to come to Malamulo.
On arrival, she was visibly struggling to breathe and anxiously worrying about her newborn whom she had left at home. The overnight clinician on call quickly recognized the signs of heart failure and gave her a high dose of intravenous diuretic. Timothy R. Gobble ’12, internal medicine specialist, saw her a few hours later, and she was already feeling better. A quick ultrasound scan of her chest and abdomen revealed dilated cardiac chambers with ventricles that were not squeezing adequately. Additionally, he saw signs that fluid had accumulated in and around her lungs.
While it’s not exactly clear what triggered her heart failure, the medical literature is clear that such patients need a set of medications that will block specific neurohormonal axes that directly and indirectly affect the heart’s function. To give Faith’s heart the best chance at recovery, she needed a specific set of drugs, dosed and titrated correctly.
Over 75,000 patients per year come to MAH. An increasing portion of these patients suffer from severe non-communicable diseases. Unfortunately for most patients like Faith, they frequently receive only a fraction of the drugs they need, and what they do get is often underdosed. This is because many drugs are expensive or unavailable, and most providers haven’t been adequately trained. The lack of access to basic laboratory and echocardiographic imaging compounds the problems. This is of great consequence because modern medical therapies, when used correctly, will dramatically improve the length and quality of life for patients like Faith.
In February 2019, Dr. Gobble started a regular referral clinic at MAH specifically for heart failure patients after seeing the needs of so many patients just like Faith. Some are elderly with longstanding hypertension, chronic lung disease, or schistosomiasis. Some are young children with rheumatic heart disease. Many, like Faith, have their own young children to care for and don’t have time to be sick, bouncing from clinic to clinic. The heart clinic provides all patients with access to a provider with adequate expertise, basic echocardiographic imaging, and appropriate medical therapy.
To this day, Faith returns regularly to receive a quick exam and get her drugs refilled and titrated. She’s been unable to breastfeed, but her baby girl is growing and developing well. However, to maintain this level of access to care for these patients, the services must be provided as inexpensively as possible. For the people of rural Malawi, a hospital bill of even a few dollars can be an insurmountable obstacle. Because of this, Adventist Health International has developed a special fund to help these patients. To donate to the Heart Clinic at Malamulo Adventist Hospital, and have a profound impact on these patients who so need our help, go to ahiglobal.org/donate and designate “Malamulo Heart Clinic.”
Dr. Gobble is an internal medicine specialist who worked at Malamulo Adventist Hospital from May 2016 to May 2021.
Dr. Thomas is a pediatrician and the current medical director at Malamulo Adventist Hospital where he has served since September 2018.