Trustees Journal part 1
A few months ago we were contacted by John and Charlotte Hutchinson who have many years experience teaching and nursing in Africa. Now in retirement, they are devoted to charitable causes in Malawi. They heard of Angels International and approached us with a request for help for two impoverished mission hospitals, at Mtendere and Nkhamenya. In October, Trustee Karen went with John to Malawi to assess the situation . Here are excerpts from her report:
Research visit to Malawi 9th - 17th October 2007. Karen Roberts (KR) accompanied by John Hutchinson (JH)
Caught the 8pm Kenyan Airways flight from Heathrow to Nairobi and then connecting flight to the capital of Malawi, Lilongwe. Arrived in Malawi at around 9.45 in the morning. (Time difference 1 hour on from BST)
Larger airport than I expected. No problems with customs. They wanted to look at the disposable gloves I had taken but when they heard they were a gift for a hospital, they were fine .Met by an extremely sprightly Sister Margaret. She is a nursing sister of the Order of the Holy Rosary and is Sister in Charge of Nkhamenya Hospital. She had come with a driver to pick us up in the one reliable hospital ambulance. She was very welcoming and was delighted to see JH
Drove about 40 mins to Lumbadzi Clinic, (Govt. run maternity to 5 yr child clinic ) Sister M had run out of any liquids suitable for cleaning wounds and she wanted some from here.
I asked if I could go with her and followed her in , both of us picking our way through a mass of pregnant women and girls sitting outside in the dust and on the steps in the burning sun with countless toddlers running crying sleeping around them. Went in to a very small room where vaccinations take place v. hot and full of flies. The lady in charge went to search for anything that would help SM. 20 mins later she came back with at most ½ litre of liquid, saying it was all she could spare. SM explained that the clinic would always give her what they could (not much in most cases) She said that the clinic did not have regular deliveries from the Govt and never knew what would arrive and when.
Back in the van and drove north from Lilongwe for about 2 ½ hours. Very flat open land with trees, mud huts with straw roofs and handmade mud brick houses with corrugated iron roofs strewn everywhere. Goats, chickens and dogs in between.
This seems to be a country of great contrasts. In the small town where we stopped for a drink there were 4 wheel drive cars and some people looked reasonably well off. Others, with ramshackle stalls selling anything from coffins to raw sugar cane along the side of the roads. Hundreds of bikes and people, travelling for miles along straight tarmac/dust roads.
The nearest town to Nkhamenya is Kasungu which appeared to be just like all the other towns we had passed through. Turned off the main tarmac road up a very bumpy track and arrived at Nkhamenya with the hospital, convent, nurses' and workers' houses and girl's secondary school and 2 primary schools altogether.
My first impression was that the buildings didn't look too bad at all. Introduced to the other 3 nuns. There is another Sr Margaret who is also a nurse , Sister Mary who is the Headmistress of the secondary school and Sister Jane who does community work and runs the goat and chicken keeping. (There is an ingenious goat house where the goats travel up a ladder into their home to be safe at night and the goat dung falls through widely spaced floorboards providing excellent compost to be collected in the morning. (pic 4)
During the evening meal the electricity went. Apparently this happens most evenings for 1-2 hours. JH was staying with the 2 Fathers who ran the boys' Primary School. I slept in the Headmistress's house. I had my own room and bathroom. Also staying there was a lady called Victoria who was at the school for the next 3 weeks as an outside invigilator for the Form 4 exams (age 18/19) All very friendly. Most nights we were in bed by 9 - 9.30pm. The sun set at 6ish, supper followed at 6.30 and then bed.
I was provided with a mosquito net, although there seemed to be very few mossies around as it was the dry season. It will be a different story in a month, as with the rains come swarms of mosquitoes and with them comes Malaria.
The sisters were called to Mass at 6.am. Sister Mary came back to the house 7am and asked if I wanted to have a quick look around her school. There are over 500 girls there from 11 to 18/19 years old. It is a boarding school which is fairly common. The Church and the Govt. share the running costs fifty fifty and also share the selection process. The girls come from all over Malawi and stay at school 3 months at a time.
The classrooms are very crowded with 70 girls in each. There was a Beit Trust plaque on the side of one of the buildings dating back to the 1960's. I had to take pictures of the girls (everyone wants their picture taken) and Sister Mary was called away so she told me that I must go to every class and see all the girls.
(pic 5) None of the classes I visited had a teacher present but they were all quietly studying. Very impressive. The calm was destroyed as soon as I took their pictures. A riot of noise ensued.
S. Mary was telling me about the overcrowded classrooms but later I talked to Victoria who teaches at the Govt. run secondary school in Kasungu. She said that there , only the 18 year olds have chairs and there are no desks and very few books of any sort.
Most of the poorest people around this area are subsistence farmers. Cultivating their own land to produce food takes all their time, they don't do other work. ( Pic 6) Victoria said that most of the locals would not have seen the lake (around 70 km away) They can't afford to get there and many don't believe it exists. I also asked about the wildlife. She said that most people have never been to the Game Reserves..The school occasionally takes the students there and the school pays for a guide.
By this time it was still only 10 am and JH and I were asked if we wanted to go and see how the outreach clinics work. These are held in outlying villages 30 or 40km away from the hospital. The ambulance -the one working ambulance, takes 6 or 7 staff to these villages to monitor pregnant women and children under 5 and dispense drugs for HIV (HIV Unigold ) They visit each clinic once a month.
Today we were going to CHINJOKA which means big snake.(pic 7)
We stopped off at a small Govt. run 'Maternal and Childhealth Clinic' in Kaluluma, not very far from Nkhamenya. I asked if I could go in but they were in a hurry to get to Chinjoka and were just picking up this HIV Gold medication. It took us about an hour to get to Chinjoka. The tracks were very bumpy and it was in the middle of nowhere.
They were going to perform several tasks:
- Weighing of under 5 year olds
- Vaccinating the under 1's against polio, measles TB and a Betavariant
- Giving out Vitamin A to all under 5's (one dose each year)
- Checking the under 5's for malnutrition
- Ante natal checkups
- HIV treatment and counselling
- Dispensing anti malaria tablets and iron tablets (in very small quantities as they always have a shortage of iron tablets)
They try to give BCG's and polio vaccines to day old babies in the hospital before they leave but if a mother has had a baby in the bush, they will do it as soon as they can. (pic 8)
The weighing took place under a tree and I have never seen so many babies and toddlers. There must have been 70 plus mothers waiting in this one village, most with a baby and a toddler in tow. The scales were hung on a branch of the tree and each baby hung off the scales in the cloth their mother cradles them on her back. The clinical assistant George who spoke good English told me that they don't use scales with a bowl as they have many cases of scabies and it was spreading through the weighing bowl.
There are 300 HIV patients registered at Nkhamenya under treatment (pic 9) Of course they only start this treatment when they are at a certain stage of the disease so that doesn't mean that a lot more don't have it, they just don't know. Those that do register are given numbers not names as there is still a stigma attached to HIV.
The whole clinic area was empty of almost any men except for Medical Orderlies from the hospital. The HIV clinic took place in the same hut as the antenatal checks, but in a different 'room'. Each woman had a record book and they were collecting a small amount of money from those who could pay . The iron tablets are very important as there has been a big increase in anaemia in expectant mothers and children. Sister Margaret said that they think that this is linked to HIV and the lowered immune system.
There were loads of small children (6-12 year olds) around and JH and I were surrounded by them, all wanting to get a good look at these strangers!
At this clinic there were 76 pregnant women. I sat next to Sister Margaret No 2 who was taking down all their details and checking them and their record cards. She was also giving them advice about their pregnancies. She did it in a very casual chatty way and they were not intimidated by her. It seems that the sisters are greatly respected by these women despite the fact that many of them did not share their religion. (Pic 11)
SM No 2 told me of a few of the women who they have put down as at risk and she has told them to get themselves to the hospital as soon as they can. One of these she said has 9 children, says she's 29 but SM knows she's 42!!
Medical staff and the Govt apparently send out warnings to these mothers that it is not advisable to have more than 5 children but they are rarely listened to.
The clinic finally finished by about 2pm and we all bundled in to the ambulance for a very bumpy ride back. We were all very hot by now and very dusty.
When we reached the convent, we were ushered in for lunch and then SM asked us to go straight to the hospital as she had gathered the staff to meet us. We were taken in to a large room where most of the staff of the hospital were waiting (over 70 of them) We had to sit at the front facing them all with SM .Then followed several speeches the first of which was from Peter who is SM's right hand man in admin and is extremely capable.
After 3 speeches, an ominous silence and then SM leant across and whispered "It's your turn now Karen" I just told them the history of the charity and what my trip was all about. A procession with wonderful African singing, the delivery of a cake and a little touch of African dancing followed. We thanked the staff for all the information and I went back to Sister Mari's house to have a quick warm shower before the electricity went off. (Pic 13)
Bountiful supper of nsima (maize) chicken potatoes, spinach and ground nuts and a green bean dish. Most appetizing. The nuns tend to eat very well.
The day began with a tour of the Hospital.
We started off in SM's office and were soon joined by Peter, her administrator then went through the questions that we had prepared before the trip: (Pic 14)
SM didn't know what % of patients were Muslim/Protestant but she said that it didn't matter, the hospital treated everyone. In fact today had been made a holiday, being the end of Ramadan and SM had said that later a group of Muslims were coming to the hospital to give presents to the patients. I have subsequently read that the Muslim population is about 20% of the whole.
The hospital receives no medicines from the Govt. apart from those that patients are entitled to have free. These include vaccines, supplements for pregnant mothers and HIV drugs. The hospital do charge for treatment but allow patients to pay in instalments and some patients who can afford to, pay more than others. There are private rooms in all the hospitals for those who can afford to pay and do not want to be on the ward with countless others.
Non church staff have their wages paid by the Govt now but not pensions. All mission hospital workers have to organize their own. In service training can be anywhere and again is not provided in the same way as it is to employees in Govt. institutions. CHAM (Christian Health Assoc. of Malawi) do help but not with money. (Pic 16) If SM's patients need a doctor they have to go to Kasungu Hospital, about 50km away. Quarterly a doctor from the diocese main hospital St John's, visits.
Before the agreement with the Govt to pay for all maternity patient costs began in 2006, mortality rates of infants was more than 1000 a year. In 2003 2004 2005 Kasungu District had the highest rate of mortality in Malawi.
A mission hospital has many organizations monitoring them. They are visited yearly by the Medical Council of Malawi and pay them a yearly premises fee. They are also visited by the Nurses Council and the Medicines and Pharmacy board and have to pay fees to both of these. Peter said how hard it is for the hospital to afford drugs. Monthly they have to send their books to the Govt. but never get any feedback. Peter said they were always asking for some kind of feedback as they do all the work and it's very demoralising never to be told how you are performing. I heard the same complaint at Mtendere.
Every month all records of diseases including HIV are sent to the Govt,the diocese CHAM ,the DHO and Ministry of Health. Again no feedback so they don't know how this compares to other hospitals. I asked if they had regular help from outside organisations. A charity called INTERCARE send antibiotics suitable for HIV patients twice a year.
The building of an operating theatre was sponsored by the BEIT trust in 2004 but needs to be completed. None of the electrics or water works are fully functional and the operating theatre is plastered, but not yet tiled.
SM did explain that the people in the villages still seek traditional healers, especially if the hospital is a long way off. More often than not this does not work but by then they are often very sick and then to have to transfer them to Kasungu proves fatal. Often sick people from the villages are brought in by ox cart and are taken back to their villages the same way . (Pic 18)
The HIV problem is worrying. From Jan through to July this year Nkhamenya had 99 new cases of HIV between the ages of 15-49 male and female. And PMTCT (pregnant mother to child transmission) 13 cases.The PMTCT scheme seems to be working with the hospital having the drugs available to treat mothers who are positive. The other HIV drugs, SM says that occasionally they run out as the drugs have to come from Lilongwe but can source more from Govt. run local clinics and these are given to them free of charge.
The Lab (as I later saw) is just a room and patients are seen in this room. They have one microscope and an ancient looking centrifuge. That was it. SM wants to be able to send her lab man away to train for further qualifications so that with the right equipment they could test on site. The tests are not complicated, mainly they need to be able to test for anaemia, malaria and TB.etc (Pic 19)
The hospital pay for their mains electricity. As there are cuts most evenings, the hospital has a generator.
Training courses are few and far between as the Govt tells them where they have to go and if it's the other end of Malawi the hospital cannot afford to pay expenses.
The premature baby room has 2 warming boxes which serve as incubators. The baby is put in this with a hot water bottle. No resuscitation equipment.
I talked to various nurses about the idea of foreign medical staff coming out to help and the impression I got was that it was a mixed blessing. They were more than happy to have the help but most 'outsiders' only stay for a few months, often change their minds about how long they will stay and so the nurses can be left struggling again at very short notice.
We then went on a tour. The hospital wards are built round a courtyard, very pleasantly planted and carefully tended.
Water for the hospital comes from the river and is pumped into a tank. I asked if it was treated and got an answer that it was if they had the chemicals. This is the drinking water too. (Pic 20)
They have to employ a guard by the pump as people keep stealing bits of it.
Went to the Outpatients dept. All the rooms are off a very narrow corridor. There is a small waiting area there for about 15 patients at a squeeze, the rest stand about or wait outside. When I was there about 30 people were waiting outside sitting on the grass/dirt. This is fine in the dry season, but what do they do when the rains come? (Pic 21)
SM showed us her store room which did have drugs but not vast amounts. She showed us the vitamins that JH and his organization had donated and two blood pressure gloves. In the Dental room (again an almost empty room ) there was a very strong smell of gas. There were two dental technicians working on a man sitting half conscious in a plain wooden very upright chair. These technicians come from St John's Hospital quarterly to clean and fill teeth. Their equipment looked extremely ancient. The hospital has one small - very small autoclave for disinfecting instruments balanced on a tiny electric burner and 1 fridge to store vaccines. No back up. (pic 22)
The hospital staff go into the villages regularly to follow up on the under 5's who don't come to the hospital regularly. They should do, as checks and vaccines and vitamin treatment are all free for under 5's.
The hospital is also trying to organize some kind of youth programme on a Saturday morning. There is widespread unemployment for school leavers and a certain mindset amongst the older orphans that make them more likely to cause problems as teenagers. The hospital wants to provide counselling and simple skill training for them. An idea approved by the Govt. but without funding.
The Isolation ward is used mostly for the treatment of whooping cough, measles, TB and Aids if its full blown. The VCT was not open as they had run out of anti viral drugs that day.
The pregnant ladies in waiting are all in one small room with their guardians, luggage, parcels of food stuffs. Bundles of fire wood for cooking all at the back of the hospital.. Again it is fine in the dry season when they can be outside for most of the day but in the rainy season it must be horrendous. The cooking area is under shelter and sufficient for their needs. (Pic 23)
We then went and wandered round the rest of the mission land seeing where the staff live, down to the river to see where the water is sourced and to the farm area. Two rivers meet on this land, neither of them very big, the Mzuzu and the Nkhamenya. Hospital workers are paid 500 kwa per month (£2 ) to tend the land and plant crops. They have a maize mill, a diesel run grinder which grinds the maize in seconds, for a small fee.
They sell the extra maize flour for the hospital. (Pic 24)
At the end I asked SM what their main problem illnesses were at Nkhamenya.
- She said; malaria; only pregnant mothers are given malaria tablets. Children are not.
- Anaemia in women and children. This has increased tremendously and it is thought to be HIV related.
It can lead to miscarriages very late in term.
- Respiratory problems in both women and young children.
- Pneumonia and Diarrhoea are big problems.
Sister Margaret is engaged in a wholly genuine struggle for the good of her community.
It would be a rare opportunity for us to work with her and she would provide us with a thorough introduction to working in Africa.
Nkhamenya has many needs and we could make a great difference here.