Could it be that simple?

It happened during lunch. This May our Disability Care ministry in Malawi was hosting a speech and language training led by visiting volunteers Kara and Rebecca. Suddenly, three children started coughing. That might not seem like a big deal at first, but, “If you don’t have a base of medical knowledge, you may not know that coughing means a child could be choking on food,” explained Kara. “It could be going down into their lungs.”

As speech language pathologists (SLP’s), Kara and Rebecca recognized that these coughs were cries for help. They knew that muscle weakness from disorders like cerebral palsy made it difficult for the epiglottis to close properly to prevent choking. But for caregivers and their children at the training, these coughs were just a normal part of their feeding routine. No one knew how to stop it from happening. Thankfully Kara and Rebecca knew the solution to decrease the risk of choking—food modification and proper positioning.


Visiting volunteer, Rebecca Latterman, shows a group of caregivers the various consistencies that can be made with food and water to help reduce choking risks.


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“We wanted to figure out how to modify nsima, a local food staple,” Kara told us. Nsima is made from water and corn flour. It is often bland and has a sticky, thick texture to it. Kara and Rebecca worked alongside a local Malawian, who taught them how to make the meal. They also learned what resources were locally available to modify food thickness.

During the trainings, Kara and Rebecca demonstrated these techniques to local volunteers, caregivers, and Kingdom Workers staff. They also showed them how to use a special chart called IDDSI* to determine the best kind of food consistency for a child. “Now moving forward, Kingdom Workers staff can know, ‘Ok this child is at a level 2 for liquids, they need it to be a little bit thicker’” said Kara. “[IDDSI] is an objective tool that helps them monitor progress and know where a child is at when they come back and visit.”

The tools and training made an impact on everyone there. For Hamilton Kambalame, Physiotherapist, it was motivating. “It was exciting to work with them,” said Hamilton. “In Malawi we have fewer than 10 qualified SLP’s. It means those skills can only be accessed by a few. But when you bring these skills to the rural areas, it means a lot to the people we serve and for the local volunteers who will use the training to make sure that people with disabilities have access to these services.”

“I was working with a child who was coughing a lot and not handling liquids very well,” recalled Kara. “We thickened up the water a little bit and gave it to him on a spoon. I loved seeing the look on his mom’s face when he started smiling. He was like, ‘Oh I’m so ready to eat it!’ He was no longer having any problems.”


By making slight changes to food thickness, Kara Darling was able to help this mother better feed her child. The smiles on their faces say everything about just how impactful this workshop was at helping children be able to eat without choking.



With just a few changes, an issue that had plagued young children with disabilities started to disappear. Hamilton told us that, “The things they taught us seemed so simple but were very key in helping children with disabilities in terms of feeding and swallowing.”

And the simplicity of the solution means that parents can easily and consistently replicate the technique to help their child eat and drink. Hamilton and Davie, our Malawi Disability Ministry Lead, recently visited a village where the trainings had been held. “We went there for a refresher training, to see the volunteers and children,” said Davie. “I remember I was chatting with one of the people there who said that the training helped a lot because their kid is no longer choking now that they know what to do when feeding her. I think that is encouraging.”

And the impact of the training wasn’t just physical. Kara shared, “It’s definitely made me stronger in my faith. These volunteers and caregivers gave up entire days to come and learn how to help children in their village. It was just amazing to me to see what they are willing to do to help these kids. I was able to teach what I knew from my schooling, but I learned so much more from them all.”

Change like this is possible when people do everything they can to serve others for God’s glory. That’s why visiting volunteers like Kara and Rebecca matter, why staff like Hamilton and Davie are important. And why the willingness of our local volunteers and caregivers makes all the difference. Together, we’re able to bring lasting healing to people in Malawi and beyond.


Hamilton Kambalame, Physiotherapist, has taken what Kara & Rebecca taught and is now sharing that with communities all throughout Malawi. 


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