Nurse Report from Malawi 2010

On this trip, we have been honored with so many great moments.  From intimate visits with hospital patients, outreach clinics and afternoons spent with the home based care teams in the rural communities. The dangers of infectious diseases such as malaria, Hiv/aids and tuberculosis are well known.  What isn't so widely realised is the attempts made by the local communities themselves to improve their own conditions. 

On our first day, we were taken on a tour of the hospital.  We were immediately struck by the pride the staff took in their efforts to provide up to date care and education.  The beds were old and rusty and the wards looked drab compared to our hospitals. In the post natal ward, we met a woman who had delivered twins during the night.  She walked home 4 kms the next day with her mother in nearly 40 degree heat.  An 18yr old pregnant girl was admitted next day; she had been unwell for five days. They travelled 14 kms on foot with a bike stretcher.  Unfortunately, she died during the night.  There seemed to be many sad stories every day. 

Most mornings, we went to an outreach clinic for under five years screening, antenatal checks and mother and baby vaccinations. All the women were patiently waiting with their own medical record booklet.  Some had covered these with newspaper to keep them clean or away from the rats. Again we made great use of scarce resources.  Any wastage was recorded.  These sessions were held in a single room with no paint on the walls or water, no glass in the windows or no covering on the floors. The women sat around on the floors patiently waiting. We were amused to see how the staff used the nearest tree to hang the babies weighing scales.  Despite the circumstances all examinations and treatments were carried out quickly and efficiently.  With so many babies around not one cried as the mother immediately breast fed at the first whimper. 

Afternoons were spent visiting the rural villages with the Home Based Care Team who usually took a bag of maize to the village.  We were often welcomed by singing village women or children.  Chairs and mats were brought out and the meeting began. These meetings also included a number of volunteers within the community who relayed information on the neediest people.  Permission was obtained from the village chief to visit the sick.  

Conditions were extremely primitive, most lived in one room huts with thatch or galvanized iron roofs. One woman we visited had been paralyzed and incontinent for five years, she sat outside the hut in the heat all day.  Her son cooked for her.  The main worry for her was the rains were due for the next four months her roof was leaking and they could not afford the plastic lining which cost about ten euro.  Also the stones of the walls were ready to collapse and the fear was she would be buried underneath.  There were many such difficult stories but also some impressive initiatives with the home based care teams. 

We were particularly impressed with the first line Home Based Carer. He was part of the community and the first port of call for sick under fives.  He received one weeks training and followed a strict protocol with a limited number of drugs.  He was very proud of his meticulous record keeping.  He had a line of communication to the Home Surveillance Team up to the Community Health Nurse.  We would like to see this role developed or more support offered, as it seems to have the potential to help the community to help itself. 

On our final day we attended a local wedding.  It was so joyful and full of colour and song.  We were greeted by some of the women from the outlying villages who recognized us, we almost felt like one of the locals.   

By the time our visit was over we felt saddened to leave the warmth of our new colleagues.  Our overall impression was of a people with dignity and real openness, a socially deprived area but with hope for a better future. It is an experience we wouldn't have missed.