my short walk through the health crisis here in malawi

Kamuzu Central Hospital

I was volunteered to escort two patients and their families for review by a paediatrician in town… this is the girl who has never actually been to the hospital, or has any understanding of how the system works, or doesn’t yet speak fluent Chichewa... Hmm.. I was a little baffled, but there really wasn’t any other options, we are in the middle of workshops, lots of staff shortages from illness, it was a big day with lots of kids, so we had a quick meeting at the start to decide who would take on this responsibility, and despite much protest, the job was given to me! I was given heaps of instructions about where to go, who to talk to, how to make sure you don’t line up in this line, make sure its that line, and make sure this.. and make sure that… ahhh… it was very scary, anyway, just as we were pulling out of the village in the bus, another vehicle returned with the home visit crew, so morgan jumped in with us so I wasn’t alone. We were taking two children for review. A little two year old boy with downs syndrome, and terrible heart issues requiring investigations, and another brand new three month old baby girl, with severe failure to thrive, no suck reflex,grossly underweight, not breast feeding, and basically slowly starving to death.

So I conducted a swallowing assessment on this tiny tiny baby as we bounced around in the minibus toward the hospital...The reviews were rather uneventful, the doctor reffered both cases onto a muzungu doctor from the UK who was fabulous with both our babies, and we were soon on our way, although the minibus to pick us up was more than an hour away. Neither mum or baby had eated anything all day, so I searched around for places to buy some food and drinks for them… but its certainly nothing like royal childrens hospital with any fancy Macdonalds or Cafeterias… but I eventually found some water, coke and banana’s.

The mums settled under a tree, and Morgan and I set off for a tour of the hospital. We ran into one of our SOS mums who directed us to two of our children who had been admitted, one with pneumonia and the other for malaria. so we spent some time visiting them......and here begins my reason for sharing my hospital experience with you. The tour with morgan was absolutely overwhelming. I saw nurses only once, which was in the high dependency unit, of which there are many, and there was only one nurse. All patients admitted to hospital have to have a friend to stay with them, to bathe, care for and feed them.

Often in hospitals at home, to describe your hospital you would firstly indicate bed numbers, and secondly maybe the types of wards or specialties are. I can't do either of these things..... there are 600 beds (i think) but numbers usually admitted reaches up to 1000. Admission to hospital certainly doesn't garantee you a bed or even a room inside the building. There were sometimes two babies in a cot
Mums would sleep between the cots on the floor or under the cots if two babies were sharing. You have to bring all of your own food, and linen. There were people everywhere. Just everywhere. Pieces of material where laid out on the concrete floor underneath some beds where more patients lay. The main block of wards had four levels, or which there were balcanies spread all along, each balcony is also a place that patients lie. I have no idea how the manage infection control. actually... they don't.

But whats astounding is that there are three other hospitals in town of the same size... i mean it is the capital of malawi, and probaly millions just in around lilongwe...But the things is, that on every street corner in town there are chipatala’s which are clinics that are also known as hospitals, people can have babies, minor surgery, short stay wards to receive all sorts of treatments.. so the three giant hospitals hardly even scratches the surface of the enormity of health care demand in this city. There are areas within Lilongwe that hold 100,000 people. and you would know it by their size or the infrastraucture/housing/development. Its just astounding.

I had a patient come in to the clinic today who have both clearly had strokes, and neither will have any opportunity for a CT or God forbid and MRI. There is one CT machine in Malawi, and that’s in Blantyre.

The enormity of the paediatric wards was just overwhelming. We went through as many wards as we could in about 40 minutes trying to find a patient to visit, we didn’t go to all of the wards, we were looking constantly and we didn’t find him, so that gives you some of an idea of how big it was… but with the population so paediatric dominant, I guess its no surprise. But with our two hospitals in ballarat…for a catchment area of the entire Grampians region... one closed down its paed ward, and the other sometimes only had 5 or 6 kids… I am just blown away. There would have been 400 or 500 hundred maybe, and that’s only at that hospital, and then there are soooo many more people in Malawi who would never see anything other than their own rural village in their entire life, let alone actually see a hospital in their lifetime.

We were passing a line to get into another section, and a lady stood holding her baby, vaguely staring into the distance, I have never felt such shock as I did when looking into her arms, the baby was clearly not alive anymore, I think Morgan knew i had seen, and kindly took my arm to help me move along, he didn't speak for about 5 minutes, just stuck by my side and lead me through the long hallway with wards off to each side overflowing with people, we walked silently for what seemed like forever. i didn't even know how i felt. the air was thick with noise, and odours of all sorts, i kinda wanted to cry, and kinda wanted to just get out of there and hide. but i also had so many beuatiful kids smiling at me, and mums greeting me with such exhuberance all the way along the corrider that i couldn't help but smile as well. i felt so many conflicting emotions. we then got trapped behind a big line of people and had to wait for some time to move past everyone to get outside. It was then that morgan turned to me and said.. "maybe she just didn't know what else to do" and he then took my arm again, and we pushed our pay outside, as he walked he just quietly prayed for the strangers in the corrider that had affected us both so deeply.