Below is the link to a You Tube video tour of the St. Joseph's property and surroundings where I spent the last 3 weeks. (I am now back in Canada and feel priviledged to have had the opportunity to experience Malawi - albeit briefly)
http://youtu.be/9n9dG5KafmU
Sunday 30 October 2011
St. Joseph's Hospital Nglundi, Malawi (Summary)
St. Joseph’s is considered to be one of the bigger regional hospitals. It is a “private” hospital which means that it levies a charge for all services. Given that the salary costs are fully covered by the government of Malawi and the anti-retroviral medicine is provided free through the government, it means these charges cover other drugs, supplies and operating costs. This still imposes a considerable financial burden on the patient and St. Joseph’s indeed does not collect all that it charges due to thepoverty of the people it serves. Without the charges, however, it could not survive financially. The operating picture of St. Joseph’s is as follows:
Catchment Area
The total population of the hospital’s official catchment area with a size 184 sq km is estimated at 56,275 people (2009 census). This population consists of approx. 10,515 households divided over 119 villages within an average radius of 10 km from the hospital. The population density is one of the highest densities in rural Malawi and has a strong mixture of tribes.
The Community
The lifestyle is based on subsistence farming. Only a minority of the population has a paying job but even they are engaged in agriculture to produce their own food due to low wages. The main crops grown are maize, cassava, groundnuts and rice. Other crops are vegetables like tomatoes and cabbage and fruits like bananas and mangoes.
The area is prone to drought and there is very little water conservation. The water supply from the Blantyre Water Board is very unreliable and pump water from boreholes is limited due to very poor pumping equipment. As a result, there is no readily available source of water. Similarly, the supply of electricity is also unreliable and there are frequent blackouts. The sewage system is by way of septic tanks but the system is very old and in need of rehabilitation.
Malawi’s social indicators and health indicators are amongst the world’s worst. The health burden of the HIV/AIDS pandemic is enormous and is one of the leading causes of death in the most productive age group (20 to 48 years).
St. Joseph’s Operations
· Staffing levels @ 85% of approved 227 positions
· Staff vacancies @ 44% for nurses and 35% for clinicians and other HPs – lab tech, pharm and rad)
· BUT spending is @ 105% budget > budget based on prior actuals vs approved positions
o 2004 9,774
o 2005 11,640
o 2006 15,311
o 2007 16,839
o 2008 17,657
o 2009 18,570
· Diagnoses
o Malaria 24%
o Respiratory 16%
o HIV/AIDS 7%
o Trauma 6%
· Note diarrhoreal and malnutrition have been reduced due to improved water and sanitation and improved food security
· In-Patient admissions
o 2004 3,330
o 2005 5,560
o 2006 6,216
o 2007 6.975
o 2008 7,640
o 2009 8,285
· Diagnoses
o Malaria 42%
o Other non-communicable diseases 29%
§ eg. Asthma, epilepsy, sepsis
o Pneumonia 8%
o Trauma 5%
o TB 3%
· 2009-10 In-Patient Metrics
In-patients | # Beds | # Admission | Nursing Days | % Occ | ALOS | Deaths | Death Rate per 1000 |
Female | 33 | 1,485 | 4,675 | 38.81% | 3.15 | 40 | 26.94 |
Male | 36 | 1,641 | 5,133 | 39.06% | 3.13 | 53 | 32.30 |
Pediatric | 56 | 2,781 | 8,642 | 42.28% | 3.11 | 55 | 19.78 |
TB | 34 | 218 | 2,450 | 19.74% | 11.24 | 9 | 41.28 |
Maternity | 37 | 2,111 | 6,145 | 45.50% | 2.91 | 1 | 0.47 |
Nursery | 4 | 49 | 31 | 2.12% | 0.63 | 2 | 40.82 |
200 | 8,285 | 27,076 | 37.09% | 3.27 | 160 | 19.31 |
· Preventative Health Care Service: Primary Health Care Program
Also of note is the growing Preventative Health Care Service: Primary Health Care Program. The core of the program is the Health Surveillance Assistant and there are 36 of these people. They are trained by the District Health Office but are linked to the St. Joseph’s Primary Health Care Team comprised of 4 community health nurses. The focus is on behavior change, early detection of infectious disease, immunization, pregnancy detection and home based care.
Friday 28 October 2011
Day 29 to 30
The flight home takes me over some magical names: Dar es Salaam, Zanzibar and Mount Kilimanjaro (Tanzania), Entebbe (Uganda), Mombasa and Narobi (Kenya), Addis Ababa (Ethiopia), Khartoum (Sudan) where the White Nile and the Blue Nile meet, and then following the Nile over the Aswan Dam and the relocated Sphinx to Cairo, Tripoli (Libya) and a lay-over in Amsterdam.
Leave today at 12:00 and arrive home Sunday about 6:00. See you soon
Day 26 Mulanje
Visited the biggest attraction in Malawi (after the Lake) – Mt Mulanje and its tea plantations. It is a great spot for hikers and there are plans to boost it tourism appeal by introducing rock climbing (up)and para-sailing (off) the mountain. On the way, we visited Mulanje Mission Hospital. It too had a very friendly, clean and appealing atmosphere and was surrounded by school system much like St. Joseph’s.
Days 25 Village Outreach
Today I joined the Primary Care Team as they ventured out into a village to administer an ante-natal monitoring and post-natal prevention program. It was fascinating to watch and the number of mothers-to-be, and the number of mothers-in-fact, that were seen was truly impressive during the 2 hour session. One young boy whose picture you can hopefully see (background was too light) is wearing a Vancouver 2011 Olympic sweater, he was reluctant to pose but his mother was delightful. He did brighten up when I tickled the hockey player on his chest.
Sunday 23 October 2011
Days 21 to 24 Blantyre
Spent the weekend in Blantyre, the biggest city in Malawi and the oldest city in Southern Africa. It gave me a chance to clean up, catch up on news, watch New Zealand win the World Cup of Rugby and have some good meals. The city itself is uninspiring but it does set the stage for my final week in Malawi and then the long and welcomed journey home. A pot pourri of pictures are shown below.
Wednesday 19 October 2011
Why am I am here?
This is the first full week of solid “work” as I had two days at St. Anne’s in Nkhotakota split by a weekend and two full days at St. Joseph’s before the Mother’s Day long weekend. So this week will start to determine the answer to the question “Why am I here?” (vs the location question “Where am I?”).
To begin to answer the question, I return to the program that brought me here. The program is called Leave for Change and it is offered through an umbrella organization called Uniterra which is a joint venture of World University Services Canada (WUSC) based in Ottawa and the Centre Canadien d’Etude et de Cooperation Internationale (CECI) which is based in Montreal. Both organizations operate many long term international engagement programs and receive funding from the Canadian International Development Agency (CIDA).
WUSC, which is my sponsor, is a non-denominational, non-sectarian, non-government organization and a registered Canadian charity. WUSC has offices in 9 countries in Asia, Africa and the Americas (Central and South). Currently WUSC Malawi is working on the following sectors: health, education, refugee issues (Malawi receives refugees from other countries), gender equality and “livelihoods”. The mandate of WUSC is to build capacity of individuals, organizations, and society to effectively contribute to the economic and social welfare of the populations.
I am here in a dual capacity. The first is as an individual supported by my Canadian employer the Hamilton Family Health Team. In this capacity I will work within my scope of expertise which is accounting and financial management. In this regard, at St. Anne’s Hospital in Nkhotakota, I worked at the micro-level to improve the capacity of the accounting staff in their use of the software product Microsoft Excel. At St. Joseph’s, I hope to assist the hospital in the selection of an information technology solution that will better place them to collect, process and report information to governing bodies including the Board of Governors and Management at St. Joseph’s Hospital and College of Nursing.
The second, and I believe the over-ridding reason for my engagement, is to be the eyes and ears and any other sense that I can engage, for the Hamilton Family Health Team (HFHT). It is our plan to offer participation in the Leave for Change program as part of the employee benefit structure which includes a social engagement component. Many of our (HFHT) staff are involved in community service work in Hamilton and with the Leave for Change we can now extend the opportunity to participate in development work at the international level in a manner that is consistent with Canadian standards (note the CIDA connection) and in a non-denominational, non-sectarian manner (through WUSC). This is the first time the HFHT has worked with Uniterra and its regional offices, and I am hoping to take the mystery out of working in far-off places and the Leave for Change initiative so that future HFHT staff participants can engage in a confident manner.
With three weeks to spend at St .Joseph’s there is also the opportunity to be engaged in a useful capacity to assist St. Joseph’s in addressing organizational concerns. In this regard, I am meeting with the leadership team to develop organizational development priorities and to identify strategies that might be followed to allow these to be realized. As a general statement the priorities will be grouped into selective staff upgrading, general staff training, major equipment replacement and minor equipment and medical surgical supplies procurement. The overriding shortage is not the potential of the people; rather it is access to resources that would allow this potential to be realized.
So that is Why I am here. Whether I can make any of this work is that challenge for the remaining two weeks and upon my return to Canada.
Day to Day living
For reasons of which I am not aware, Malawi has adopted a time zone that makes it day one hour earlier than expected. Being directly under Kenya, for instance, it is actually one hour behind on the clock. This places it on the same time as its former British colonial partners Zambia (formerly Northern Rhodesia and Zimbabwe (formerly Southern Rhodesia). The effect is to have the day start (i.e. sunrise) at 5:00 AM and sunset in the 5:00 PM range. The work day starts at 7:30 and ends at 5:00. With the earlier darkness and rural roads with no street lighting, the evenings outside the city tend to be uneventful. In the cities there is more activity and things like grocery shopping are much like in Canada. There are smart new shopping malls with ShopRite stores with grocery and merchandise products paralleling those available anywhere – and at prices much like anywhere as well. The effect is the better-off live with most amenities (noting the power and fuel outages that affect everyone) while those in the rural settings (most of the people) live a life of subsistence.
The country is agriculturally based and as a result the rhythm of life plays off the crop cycle which plays off the rain. The best time to visit weather wise is August through October when the days are sunny and dry and warm. 30 degrees C is considered a hot day so these months are much like a pleasant summer day in Canada. The rainy season starts in November and runs through March so October is the month of planting and February – March is the time of harvesting. Maize (corn) is the prized crop for personal consumption. Being October, it is a regular sight to see people (mostly women) walking to and from the local seed markets carrying a number of seed bags on their head back to their villages for planting.
Sunday 16 October 2011
Day 15 to 17 Zomba Plateau
Mother’s Day in Malawi is a national holiday and is celebrated on October 15. Having a long weekend, I decided to see one of the highlights of Malawi – the Zomba Plateau. The city of Zomba was for many years the Capital of Malawi. It was moved following independence to Lilongwe but Zomba still remains a major university town and is at the base of the majestic Zomba Plateau. After a 25 minute climb by winding road, you arrive some 5,000+ feet up at a very nice resort called Ku Chawe. Ku Chawe sits on the cliff face and rooms (mine included) have panoramic views of the spectacular surrounding including Mt. Mulanje which is the 3rd highest mountain in Africa – behind Kilimanjaro and Kenya. Sister Mercy said she would take me out to Mulanje next weekend. It is also the centre of the tea growing region.
I went on a 3 hour bumpy Landrover ride across the Plateau and at times felt that I was in a Swiss mountain meadow with Heidi about to appear. Five minutes later and a different panorama makes you think you are in Arizona looking down on Sedona and the red sand obelisks. Another bend takes you to a view of Lake Chilwa beaconing from the distance. A final bend takes you to an imposing view of the Shire River which drains Lake Malawi and joins the Zambezi River at the Mozambique border in its rush to the Indian Ocean. Amidst this wonderful national preserve you meet men who walk their bicycles up the mountain every day in their bare feet and then walk an additional 3 miles walking across very rough terrain to a designated place where they are allowed to cut down trees. Wood is the means by which heat is generated for villages and the source of charcoal which is the sole means of cooking food. After completing this trek the men then walk back to the descent and then down the winding road to town where they sell the wood. There is a picture below which does not do justice to this ordeal. In contrast is the lovely lodge where I stayed, complete with monkey guardian and all.
Saturday 15 October 2011
Days 11 to 14 St. Joseph's Hospital and surrounding community
I was welcomed at St. Joseph’s Hospital by the delightful Sister Mercy Kanyumbu who is the hospital administrator. St. Joseph’s is a rural hospital located in a cluster of church, school, housing and hospital but serving a broader community of dispersed villages. I am staying in the house shown below which has a wonderful property and is located right across the road from the hospital. Getting to work is therefore easy (and the water is now back on). The nearest grocery shopping is a 30 minute ride by crowded “minibus” which is a euphemism for an overcrowded and antiquated van. Saying that I can always hitch a ride from one of the hospital drivers if I want to take the easy way out. C’est la vie.
The staff at the hospital are very welcoming and I am trying to find a way to be useful without being in the way. The dominant mood is one of warmth. “Poor” here is defined as not having a family around you. Saying that there is obviously considerable hardship but when that is an inherent part of life, then family is the sustaining force. Every day for me begins with the refreshing and uplifting screams of joy coming from the school yard next door as evidence of the power of community as well.
Wednesday 12 October 2011
Day 11 Off to St. Joseph's Hospital in the South
I leave today for the 600 km trip south to stay for the next two weeks at St. Joseph's Hospital in the Chiradzulu region. It will prove to be an interesting change as the south of Malawi has most of the nations population and a very different topography. It is the major tea growing area with tea being one of the major earners of foreign currency that the nation desperately needs. For example, without foreign currency Malawi is unable to buy gasoline or diesel fuels. Currently there has been a two week period where all gas stations are empty of fuel and cars sit by waiting for it to arrive.
This also marks the movement of myself from an outsider to a person more integrated into the living reality of Malawi. The change also involves moving out of the relative comfort that I have experienced during the first 10 days into an existence that provides fewer comforts. Although the guest house I will be living in looks inviting from the outside, there is no running water inside. (There is plumbing and sinks and toilets etc but the local water utility has no water to provide to the hospital or to its surroudings.) Still I am pampered in relation to those around me. Although the solid brick-look of the village houses (above) is better than expected, you then realize that families of 10 people live inside with no water, or means of preserving food, or heat (it gets cold at night), or power. The food the people eat is grown in the hard clay-like ground that predominates. Subsistence farming occupies most of everyone"s day.
This also marks the movement of myself from an outsider to a person more integrated into the living reality of Malawi. The change also involves moving out of the relative comfort that I have experienced during the first 10 days into an existence that provides fewer comforts. Although the guest house I will be living in looks inviting from the outside, there is no running water inside. (There is plumbing and sinks and toilets etc but the local water utility has no water to provide to the hospital or to its surroudings.) Still I am pampered in relation to those around me. Although the solid brick-look of the village houses (above) is better than expected, you then realize that families of 10 people live inside with no water, or means of preserving food, or heat (it gets cold at night), or power. The food the people eat is grown in the hard clay-like ground that predominates. Subsistence farming occupies most of everyone"s day.
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