November 27, 2010
Today was going to be very busy day. As I mentioned in a previous post, Susan and I came to a village that had the pump at their water supply vandalized. We had asked the chief to get a quote to see if we could manage buying the materials necessary to rehabilitate the well.
Receiving the quote turned out to be the easiest part of the entire program. I was supplied with a list containing 10 different items and given the task of finding the materials in the nearby town of Limbe (it’s on the map). The amazing thing is that no one store had more then 2 item on the list …some had none! It took Milisimo, myself and two village representatives 8 hours and $40,000 kwatcha or approximately $280 US$ to track down most of the parts. We had to visit no less then 8 stores in two cities (had to go to Blantyre also on the map) but then we had to call it a day as the hospital had only loaned us the ambulance for the day, as it was needed to transport a patient to the Central hospital later in the afternoon.
Fortunately we were able to contact a Borehole technician who was willing to assist us on Saturday to refit the well. We explained that we were unable to secure the entire list and asked if he knew where we could get the rest of the materials. As it turns out this off duty government worker knew someone who just happened to have spare parts…. we were able to negotiate price and the transaction took place on the outskirts of town…..
After we secured the materials we made our way back to the village where we were met by the Chief and her husband. Unfortunately, we arrived at the same time that everyone in the village was attending the funeral. We were asked it we could begin repairs and representatives would join us shortly. The repairs took approximately one hour to complete and at the end we were able to get the pump up and running again.
The Chief and approximately 12 or 15 of the villagers came out to thank us when we were finished. The Chief gave a beautiful speech and expressed how fate had brought Susan and I to their village last week and how thankful they were because we able to eliminate the worries of the entire village with our generosity.
Saturday, November 27, 2010
November 25, 2010
It was a quiet day but a busy day. We have two road trips planned. In the morning, we are scheduled to attend a clinic for maternal child health and children under 5 in a remote village “Nsonera” approximately 20km from the hospital. Unfortunately Malawi has the world’s highest infant mortality rate and because of this the government has put into place a number of programs including hospital clinic for those who have access to the facilities and outreach programs that bring health professionals into the rule communities.
Some alarming statistics on National Demographic:
Infant mortality rate 134/1000
Under 5 mortality rate 120/1000
Maternal mortality rate 510/100,000
Neonatal mortality rate 27/1000
Statistics on St. Joseph’s Hospital service area
Population 56,275
Under one year old 2,106
Under five years old 9,567
5 – 18 years old 18,570
Adults 28,846
Women of child bearing age 12,943
Pregnant women 2,814
2009 Maternity satatistics for St. Joe's
Total Admissions 2,111
Antenatal admissions 275
Premature nursery admissions 49
Deliveries
Total Deliveries 1,813
Total Births 1,824
live births 1,728
normal deliveries 1,353
Caesarean Section 355
Maternal death 1
Neonatal death 29
still birth 37
Note: the average life expectancy of a Malawian is 35 down from 37 since the last statistics were available. Approximately 50% of the populations are children and young adults under the age of 18. The other 50% of the population is made up of parents and grandparents unfortunately the majority of this group is made up of single parents and grandparents.
The clinic attendance was significantly down today due to the rains that have been moving across the country over the past few days. These rains were long over due and welcome by everyone….that being said, the mothers and children that were to be at the clinic were working in the field to begin their planting. We did however see 35 mothers and their babies, which to me seemed like a VERY busy clinic. Over the next couple of hours each mother saw the clinical nurse who provided a basic examination which included checking the baby’s eye lids to see if they were anemic, looking at the skin color of their hands for signs of anemia finally they plotted the child’s weight and age against a standard growth chart.
When a baby reaches the age of 6 months they are placed on a vitamin “A” supplement program until they reach the age of 5. The baby’s also begin to receive there vaccinations such as Polio, diphtheria, BCG, tetanus, whooping cough and measles. Tomorrow I will be attending the hospital’s under 5 program which I’m told we could see up to a hundred children in the morning session alone.
In the afternoon we went on a “home base care” visit to see an elderly man who we’ve been told was experiencing significant difficulties. The home care program is also part of the palliative care initiative that is beginning to gain momentum in Malawi. Clients/patients who can’t get to the hospital for treatment are registered with Home Care and if applicable are designated as either chronic or acute palliative.
Although the patient was less then 10 km from the hospital, it took us a significant amount of time to reach him. We turned off the main road onto a dirt road after 3 or 4 minutes. This road became a path within 2 KM which ended at the village chief’s house. We introduced ourselves and gained permission to continue on foot to the patient’s home further up the mountain side. Once granted, we proceeded with the assistance of a village volunteer. It took us another 15 -20 minutes, navigating along a washed out rock and mud encrusted pathway until we finally arrived at our destination. Once formal introductions were made (another 5 minutes) Doctor Susan was able to examine the patient.
This patient is in his 80’s blind, nearly deaf and has lost the use of his legs. The loss of his legs likely occurred because as he became increasingly blind he was becoming more and more restricted in his movements due to the terrain and his fear of falling. We were told that he just sits out in front of his house all day and sleeps. After Susan’s examination it looks like his blindness was caused by sever cataracts in both eyes. Cataract surgery is a free procedure in Malawi and can be done at the main district hospital near Blantyre. Arrangements were being made with his daughter and the chief to ensure he is provided transport and access to this procedure within 30 days.
Recommendations
It was a quiet day but a busy day. We have two road trips planned. In the morning, we are scheduled to attend a clinic for maternal child health and children under 5 in a remote village “Nsonera” approximately 20km from the hospital. Unfortunately Malawi has the world’s highest infant mortality rate and because of this the government has put into place a number of programs including hospital clinic for those who have access to the facilities and outreach programs that bring health professionals into the rule communities.
Some alarming statistics on National Demographic:
Infant mortality rate 134/1000
Under 5 mortality rate 120/1000
Maternal mortality rate 510/100,000
Neonatal mortality rate 27/1000
Statistics on St. Joseph’s Hospital service area
Population 56,275
Under one year old 2,106
Under five years old 9,567
5 – 18 years old 18,570
Adults 28,846
Women of child bearing age 12,943
Pregnant women 2,814
2009 Maternity satatistics for St. Joe's
Total Admissions 2,111
Antenatal admissions 275
Premature nursery admissions 49
Deliveries
Total Deliveries 1,813
Total Births 1,824
live births 1,728
normal deliveries 1,353
Caesarean Section 355
Maternal death 1
Neonatal death 29
still birth 37
Note: the average life expectancy of a Malawian is 35 down from 37 since the last statistics were available. Approximately 50% of the populations are children and young adults under the age of 18. The other 50% of the population is made up of parents and grandparents unfortunately the majority of this group is made up of single parents and grandparents.
The clinic attendance was significantly down today due to the rains that have been moving across the country over the past few days. These rains were long over due and welcome by everyone….that being said, the mothers and children that were to be at the clinic were working in the field to begin their planting. We did however see 35 mothers and their babies, which to me seemed like a VERY busy clinic. Over the next couple of hours each mother saw the clinical nurse who provided a basic examination which included checking the baby’s eye lids to see if they were anemic, looking at the skin color of their hands for signs of anemia finally they plotted the child’s weight and age against a standard growth chart.
When a baby reaches the age of 6 months they are placed on a vitamin “A” supplement program until they reach the age of 5. The baby’s also begin to receive there vaccinations such as Polio, diphtheria, BCG, tetanus, whooping cough and measles. Tomorrow I will be attending the hospital’s under 5 program which I’m told we could see up to a hundred children in the morning session alone.
In the afternoon we went on a “home base care” visit to see an elderly man who we’ve been told was experiencing significant difficulties. The home care program is also part of the palliative care initiative that is beginning to gain momentum in Malawi. Clients/patients who can’t get to the hospital for treatment are registered with Home Care and if applicable are designated as either chronic or acute palliative.
Although the patient was less then 10 km from the hospital, it took us a significant amount of time to reach him. We turned off the main road onto a dirt road after 3 or 4 minutes. This road became a path within 2 KM which ended at the village chief’s house. We introduced ourselves and gained permission to continue on foot to the patient’s home further up the mountain side. Once granted, we proceeded with the assistance of a village volunteer. It took us another 15 -20 minutes, navigating along a washed out rock and mud encrusted pathway until we finally arrived at our destination. Once formal introductions were made (another 5 minutes) Doctor Susan was able to examine the patient.
This patient is in his 80’s blind, nearly deaf and has lost the use of his legs. The loss of his legs likely occurred because as he became increasingly blind he was becoming more and more restricted in his movements due to the terrain and his fear of falling. We were told that he just sits out in front of his house all day and sleeps. After Susan’s examination it looks like his blindness was caused by sever cataracts in both eyes. Cataract surgery is a free procedure in Malawi and can be done at the main district hospital near Blantyre. Arrangements were being made with his daughter and the chief to ensure he is provided transport and access to this procedure within 30 days.
Recommendations
November 21, 2010
November 21, 2010
Woke up Sunday in Liwonde to a light shower..…are the rains coming or is this just a tease like the Malawian’s are saying? Liwonde is just north of Blantyre where we are dropped off Mala for a week to work at a children hospice. Saturday we went on a night safari drive through the Liwonde National Park...didn’t see a lot of different animals mainly elephants, wart hogs and a few impalas.
Today we made our way to Nguludi where I will be spending the rest of my time here with Susan working at St. Joseph’s Hospital. When we arrived, Susan gave me a quick tour of the facility then we made our way to the guest house. It a beautiful 3 bedroom house, basic in its amenities..… I had no linen so I’m sleeping on 4 yards of material that Susan purchased last week to make a tradition skirt and 2 cushions from the coach as my pillow.
We met up with one of the hospital drivers “Malisimo” who suggested to Susan last week that they take a walk to a neighboring village PIM. This village is a missionary site that was established in 1900 and is the home of Malawi’s most famous freedom fighter Rev. John Chilembwe. To date it is still a very active community in the region and is a commercial centre for many of the surrounding villages to sell the goods and services twice a week.
The walk took a little longer then we anticipated. We left the Nguludi shortly after 3 and expected to return shortly after five just before nightfall. Well,that didn’t happen because of the time spent taking pictures, talking to people along the way and stumbling across a situation that needed our immediate attention. We were going to stop and take a few pictures of women pumping water at a community borehole when I noticed that all the women were sitting around the well but not pumping water. I asked Malisimo if there was a problem and he asked the group of ladies. It turns out that the well is inoperable because someone stole the pumping handle and the rubber hose that draws the water from the well four days ago. Unfortunately the village does not have the resources to replace the missing equipment so the women were trying to determine what to do. In the mean time the village is drawing their water from a near by river where in many places river water is stagnant. This has the makings of a cholera problem, which will be magnified as soon as the rains arrive in a week or so.
As we were discussing the situation with the ladies, I suggested to Susan that we consider helping. We had a option of purchasing the missing equipment from Blantyre and deliver it to the village so they could make the repairs. Malisimo said that we would need to discuss this with the chief…and just at that moment the chief made her way down to the Borehole. It was agreed that the village would send a representative to the city to secure a quote for materials and report back to me Monday. Once the Chief announced what we were doing the crowed of mostly women burst out in applause.
News of what we were proposing spread very quickly and it wasn’t long before we were greeted by a village headman on the road who not only thanked us but also said for us to consider his village our home and to feel as safe here as you would in our own home.
Woke up Sunday in Liwonde to a light shower..…are the rains coming or is this just a tease like the Malawian’s are saying? Liwonde is just north of Blantyre where we are dropped off Mala for a week to work at a children hospice. Saturday we went on a night safari drive through the Liwonde National Park...didn’t see a lot of different animals mainly elephants, wart hogs and a few impalas.
Today we made our way to Nguludi where I will be spending the rest of my time here with Susan working at St. Joseph’s Hospital. When we arrived, Susan gave me a quick tour of the facility then we made our way to the guest house. It a beautiful 3 bedroom house, basic in its amenities..… I had no linen so I’m sleeping on 4 yards of material that Susan purchased last week to make a tradition skirt and 2 cushions from the coach as my pillow.
We met up with one of the hospital drivers “Malisimo” who suggested to Susan last week that they take a walk to a neighboring village PIM. This village is a missionary site that was established in 1900 and is the home of Malawi’s most famous freedom fighter Rev. John Chilembwe. To date it is still a very active community in the region and is a commercial centre for many of the surrounding villages to sell the goods and services twice a week.
The walk took a little longer then we anticipated. We left the Nguludi shortly after 3 and expected to return shortly after five just before nightfall. Well,that didn’t happen because of the time spent taking pictures, talking to people along the way and stumbling across a situation that needed our immediate attention. We were going to stop and take a few pictures of women pumping water at a community borehole when I noticed that all the women were sitting around the well but not pumping water. I asked Malisimo if there was a problem and he asked the group of ladies. It turns out that the well is inoperable because someone stole the pumping handle and the rubber hose that draws the water from the well four days ago. Unfortunately the village does not have the resources to replace the missing equipment so the women were trying to determine what to do. In the mean time the village is drawing their water from a near by river where in many places river water is stagnant. This has the makings of a cholera problem, which will be magnified as soon as the rains arrive in a week or so.
As we were discussing the situation with the ladies, I suggested to Susan that we consider helping. We had a option of purchasing the missing equipment from Blantyre and deliver it to the village so they could make the repairs. Malisimo said that we would need to discuss this with the chief…and just at that moment the chief made her way down to the Borehole. It was agreed that the village would send a representative to the city to secure a quote for materials and report back to me Monday. Once the Chief announced what we were doing the crowed of mostly women burst out in applause.
News of what we were proposing spread very quickly and it wasn’t long before we were greeted by a village headman on the road who not only thanked us but also said for us to consider his village our home and to feel as safe here as you would in our own home.
Tuesday Nov 23
Tuesday Nov 23
Todays entry was provided by Susan who has summarized her two day Palliative Care workshop.
Today was the first day of the palliative care workshop. Karen Giva chaired the event, which she actually preferred to call a briefing, a sharing of experience and knowledge as it were. The day got off to a very slow start... my heart started to sink when I found myself the first person there at 0750, after agreeing with the other facilitators, Karen Giva and Maggie Mhango from the nursing college, that we would all meet at ~ 0745 this morning to set up. The computer needed to be set up, the room had not been cleaned and the furniture still had to be arranged. Maggie and Karen arrived shortly after 0800, and it took 2 hours before we could start. Fortunately, the participants began arriving around 0900, and by the time we had lunch there were about 15. The slow start however was just “Malawi time”and once we did start, it was a great day. Discussions happened, questions were asked, some had some strong feelings about what might work for Nguludi in terms of a model of care. My role was to facilitate for each topic, add in comments, questions, stimulate conversation, etc.
Once again, I was struck by the very basic level of palliative care training we need to undertake here. Staff are doing this supportive care all the time in one way, but not recognizing it for what it is, or doing enough for various reasons – short on staff, leadership, supplies like fuel to make home visits, medications, knowledge. However, many do have the attitude required to do the palliative care, they just need the support of the hospital and perhaps PACAM to revive their program here.
Interesting examples of ‘ethical dilemmas’ came up during the session: One story was of a woman who kept ‘getting sick’ and was hospitalized every time there was a plan for her husband, who was HIV positive and very ill in the same hospital, to be discharged home. This continuned to happen, puzzling the staff, until the wife finally confided to one of the nurses that her husband was so angry over his imminent death from AIDS that he would would pressure her to have intimate relations so she too could contract the virus and die. He could not stand the thought of her living on after him and possibly being with another man. The dilemma presented was how to support the wife and still respect the right of this man to go home. Everyone agreed that he should not be discharged home and the wife would also remain at the hospital so he'd have no reason to want to leave. He finally was unable to be considered for discharge as he became more frail, and he died.
Some different models of palliative care were discussed in small groups then in a plenary session with a view to preparing the participants to discuss how the Nguludi Hospital palliative team wishes to move forward.
What I find promising is the cooperation between the nursing college and the hospital, the level of interest in being able to do palliative care at Nguludi again, and the sense of urgency to get started. I am very pleased to have been able to help facilitate this process, and share in their goal.
As for the weather, today was a doozy. The skies opened up at least 3 times. During our afternoon session at the workshop, the rain and accompanying thunder was so loud that we could not hear each other talk. We waited a while, then continued, but the paths and culverts and streets were flowing like rivers. The rainy season has truly begun. Some of the workers at the hospital are up at 0430 or 0500h to plant their gardens. Most people maintain gardens to grow what they need for themselves all year – at least maize, cassava, beans and the like. Almost everyone seems to live beside a mango or papaya tree as well. Of course, this sounds really good, but the fact is this is the only way to survive here for most Malawians, as their salaries if they are working do not enable them to support their families or themselves for that matter. Most Malawians of course do not have any kind of salary, but simply subsist on what they can grow and perhaps sell a little of that.
Wednesday, Nov 24
Day 2 of the workshop went well. We planned to start at 0900, agreed to by all the participants yesterday, and we started at about 1000! Malawi time again!! Oh well!!
That said, we had a great day. The group has settled in a little, with mostly the same people as yesterday, and the discussion was freer. The morning was spent talking about communication in palliative care, then a session by myself on pain assessment and management. Most of the afternoon was spent on team planning for ‘the way forward’ for a palliative care program at Nguludi. We came up with 14 recommendations. All of them really came from the participants, not me. I could not have wished for a better outcome.
Friday, November 19, 2010
November 19
The hospital that I have been working at here is in bad shape financially. They have been forced to reduce some of the services levels offered as well as not being able to physically reach out into communities that lie in the outer regions of their servicing area. The negative impact of this is that many of the people targeted for HIV /AIDs testing and counseling will need to travel to the mission hospital to complete the test... This may not happen because of the distance they must travel between 20 and 30 KM.
The medical supplies that we brought from Canada were very much appreciated and used to restock the pharmacy. Unfortunately the escalating cost of drugs has also contributed to the financial strain of the hospital. The hospital ran into difficulties back in 2007 and 2008 when they lost a shipping container of medical supplies in a transport accident, leaving the hospital short of drugs and forcing them to restock the pharmacy inventory from local drug suppliers. The cost of carrying this debt has put a huge financial strian on the hospital and has had a rippling effect through out the entire organization, including staffing. The constantly revolving personnel has made it extremly difficult to maintain servicing standards, as well trained and experienced staff are being repalced by less experenced staff requiring additional training. These training cost contribute to the finacial burden of the hospital and put extreme pressure on service levels the hospital provides to the community.....it is a terrible circle that they find themselves in.
The medical supplies that we brought from Canada were very much appreciated and used to restock the pharmacy. Unfortunately the escalating cost of drugs has also contributed to the financial strain of the hospital. The hospital ran into difficulties back in 2007 and 2008 when they lost a shipping container of medical supplies in a transport accident, leaving the hospital short of drugs and forcing them to restock the pharmacy inventory from local drug suppliers. The cost of carrying this debt has put a huge financial strian on the hospital and has had a rippling effect through out the entire organization, including staffing. The constantly revolving personnel has made it extremly difficult to maintain servicing standards, as well trained and experienced staff are being repalced by less experenced staff requiring additional training. These training cost contribute to the finacial burden of the hospital and put extreme pressure on service levels the hospital provides to the community.....it is a terrible circle that they find themselves in.
November 18
This week, I continue to gather information for the needs assessment of the hospital by meeting with the department heads of Accounting, Nursing, the Coordinator for HIV/AIDS, Principal Hospital Administrator and the Chief Medical Officer.
There are a number of projects and initiatives that are in various stages of development and implementation. The unfortunate situation is that each of the projects have been halted due to the lack of project funding. One project was the expansion of the maternity ward. This project started in 2008 then construction stopped in 2009 due to lack of funding. The expansion was planed to better service the community and surrounding villages. It’s estimated that Likuni’s service area has in excess of 26,000 expected mothers. Plans to redesign the Maternity ward were implemented to accommodate the increased demand. During construction parts of the ward were temporarily consolidated with other wards until the project was finished. Unfortunately these spaces have not been able to be reclaimed even though construction was halted in 2009 leaving the entire Maternity ward congested and extremely over crowded.
The other project is a proposal to start Likuni’s first outreach program. A two person team would travel approximately 20 KMs from Likuni to the district of “Masumbankhunda” and set up a clinic in a Regional Health Centre. This proposal would provide HIV/AIDS testing, dispense free AIDS medication, provide education and counseling to “PMTCT” the prevention of mother to child transmission of AIDS and palliative care. The program would also allow for the re-assimilation of HIV defaulters. A defaulter is an individual who is positive and has initially started two education and counseling sessions dealing with Basic information on HIV and nutrition after they have been identified – however they have not completed the program. The current default percentage is around 10%. Training of the staff which includes Clinical Officer, Nurse, (5) Patient Assistant has been completed and transportation has been acquired. The program will provide regular and consistent visits to the health centre to provide service for those communities to far for people to travel to Likuni. It is anticipated that the HIV testing will increase by 2 or 3 time the current level performed through the HIV clinic in Likuni Mission Hospital. Based on Likuni numbers it is expected that this centre will perform over 16,000 HIV tests which is projected to identify 1668 new positive HIV people and 89 exposed infants. This proposal was submitted approved in principle however the funding never materialized.
Below is some statistic that might be of interest to some.
2010 HIV/AIDS testing Statistics - ending October 30th
Male = 1491
Female – not pregnant = 1471
Female – not pregnant = 1471
Female pregnant = 3687
Total tested = 6649
Exposed infants = 37
Total tested = 6649
Exposed infants = 37
Positive = 693
Negative = 5915
Negative = 5915
Total = 6645
Age 0 – 17 months = 12
Age 18mo to 14 yrs = 30
Age 15yrs to 24 yrs = 201
Age 25+ = 487
Total = 730
Age 25+ = 487
Total = 730
Female 0 – 17 months = 7
Female 18mo to 14 yrs = 11
Female 15yrs to 24 yrs = 181
Female 25+ = 337
Female 25+ = 337
Total = 536
Male 0 – 17 months = 5
Male 18mo to 14 yrs = 19
Male 15yrs to 24 yrs = 20
Male 18mo to 14 yrs = 19
Male 15yrs to 24 yrs = 20
Male 25+ = 150
Total 194
Tuesday, November 16, 2010
November 16
We arrived back in Lilongwe Sunday night from Senga Bay a small fishing community north of Salima. See if you can locate on attached map.
Monday and Tuesday were very busy days for both Mala and me. Mala was getting back into her assignment working palliative care in the pediatrics ward and preparing for the first of her two teaching sessions this week. I moved into my second assignment by spending Monday with PACAM, acclimatizing myself with the organization, its infrastructure, personal and its vision.
Tuesday, I was introduced to the Principal Hospital administration and Chief medical officer. During these meetings discussions on WUSC’s mandate held and action plans put together for the balance of the week.
I began the needs assessment process with the Human Resource and finance departments. The following is some preliminary data about the hospital and its community I thought might be of interest:
· Likuni Hospital built in 1941 (has 230 beds)
· Likuni population 170,000
· Total number of catchments area 52,685
· Expected number of pregnant mothers 26,343
· Number of villages 96
· Hospital has 9 specific wards:
. Maternity (average monthly births 380 -400)
· Labour
· Delivery
· Post natal
· Natal
. TB ( separate male and female buildings)
. Pediatrics
. Male ( surgical and medical )
. Female ( surgical and medical )
. Private wing
. Outpatients
. Maternal child therapy clinic
. Clinics:
· ART
· STI
· HIV/AIDS
Monday and Tuesday were very busy days for both Mala and me. Mala was getting back into her assignment working palliative care in the pediatrics ward and preparing for the first of her two teaching sessions this week. I moved into my second assignment by spending Monday with PACAM, acclimatizing myself with the organization, its infrastructure, personal and its vision.
Tuesday, I was introduced to the Principal Hospital administration and Chief medical officer. During these meetings discussions on WUSC’s mandate held and action plans put together for the balance of the week.
I began the needs assessment process with the Human Resource and finance departments. The following is some preliminary data about the hospital and its community I thought might be of interest:
· Likuni Hospital built in 1941 (has 230 beds)
· Likuni population 170,000
· Total number of catchments area 52,685
· Expected number of pregnant mothers 26,343
· Number of villages 96
· Hospital has 9 specific wards:
. Maternity (average monthly births 380 -400)
· Labour
· Delivery
· Post natal
· Natal
. TB ( separate male and female buildings)
. Pediatrics
. Male ( surgical and medical )
. Female ( surgical and medical )
. Private wing
. Outpatients
. Maternal child therapy clinic
. Clinics:
· ART
· STI
· HIV/AIDS
Monday, November 15, 2010
Pictures
I've posted lots of pictures-click here to see the album. http://picasaweb.google.com/morris3211/Malawi#
Friday, November 12, 2010
November 12
Checked email at 5:30 …lots going on
I read a message from my cousin's daughter who's friend at Loyalist College in Belleville was shown my blog in her class. She is now following too.. turns out her teacher, Barb, went to high school with my wife, and pulled the link from Lorrie's facebook page. It was great timing as Barb's class is studying HIV/AIDS. I shared this with Mala, who said that she would be happy to provide additional content for the blog over the next weeks.
Arrived at St. Anne’s today to wrap up my assignment and to extend my respect and regards to Dr. Kizwa and his entire staff. Just before our departure back to Lilongwe, I ran into Rev. James Gumbwa who wanted to pass to me this remarkable story of the most famous tree (Mkuyu tree) in the district and possible the world.
In the mid 1800’s Dr. David Livingston mapped out many regions in Africa, which led the way for early Christian missionary work from volunteers around the world. Dr. Livingston was very much against slavery and at every opportunity spoke out against it.
Dr. David Livingston made his way to Malawi, which at the time was one of the major suppliers of people to the slave market around the world. These people were moved from Malawi transported through Tanzania to Zanzibar, their final destination before being sent out around the world. Dr. Livingston met with a Chief who supplied villagers to the slave consortium to persuade him to stop the practice. At the conclusion of the meeting, an understanding was reached and the exporting of villagers stopped. Rev. Gumbwa said that Dr. Livingston was responsible for bring Christianity to this region.
Dr. Livingston eventually died on one of his adventures in Africa and many people believe that his body was returned to England for burial. However, out of respect for his love of Africa, the Anglican Church in Zanzibar is said to have the heart of Dr. Livingston sealed in a box made from the tree of his final resting spot. Zanzibar is the country where the practice of slavery was said to have originated.
I read a message from my cousin's daughter who's friend at Loyalist College in Belleville was shown my blog in her class. She is now following too.. turns out her teacher, Barb, went to high school with my wife, and pulled the link from Lorrie's facebook page. It was great timing as Barb's class is studying HIV/AIDS. I shared this with Mala, who said that she would be happy to provide additional content for the blog over the next weeks.
Arrived at St. Anne’s today to wrap up my assignment and to extend my respect and regards to Dr. Kizwa and his entire staff. Just before our departure back to Lilongwe, I ran into Rev. James Gumbwa who wanted to pass to me this remarkable story of the most famous tree (Mkuyu tree) in the district and possible the world.
In the mid 1800’s Dr. David Livingston mapped out many regions in Africa, which led the way for early Christian missionary work from volunteers around the world. Dr. Livingston was very much against slavery and at every opportunity spoke out against it.
Dr. David Livingston made his way to Malawi, which at the time was one of the major suppliers of people to the slave market around the world. These people were moved from Malawi transported through Tanzania to Zanzibar, their final destination before being sent out around the world. Dr. Livingston met with a Chief who supplied villagers to the slave consortium to persuade him to stop the practice. At the conclusion of the meeting, an understanding was reached and the exporting of villagers stopped. Rev. Gumbwa said that Dr. Livingston was responsible for bring Christianity to this region.
Dr. Livingston eventually died on one of his adventures in Africa and many people believe that his body was returned to England for burial. However, out of respect for his love of Africa, the Anglican Church in Zanzibar is said to have the heart of Dr. Livingston sealed in a box made from the tree of his final resting spot. Zanzibar is the country where the practice of slavery was said to have originated.
November 11
The days here are rhythmic and consistent it’s like someone flicking the light switch off exactly at 6PM and flipped back on at 5AM ….needless to say our days start very early in Malawi.Thursdays, like most days at St. Anne’s, are very busy, and today is HIV/AIDS treatment day. Every Thursday the hospital’s Clinical Officer “Lester” interviews and prescribes medication to HIV patients. This is where patients with HIV typically have one week’s supply of medication left from their last scheduled consultation and meet with Lester to describe how they are feeling and if they have developed any other symptoms that likely resulted from complications of AIDS.
I was fortunate to be able to join Lester’s HIV clinic for about one hour between 11:00 and 12:00 – which I’ll tell you about that later in my update, but for now I’d like to walk you through a typical day for Lester. Lester’s day begins around 7:30am where he does his morning routine of discussing admitted patient cases, morning rounds then return to his office were he is so often met by out patients, who through word of mouth want to meet with him, as they see him as their last hope. This morning when I joined him, he had already seen two patients and another had just walked into our meeting unannounced and distressed. Listening to Lester’s well refined bed side questions, I determined that the individual was in his late 30’s or early 40’s, married with 1 child and suffers from AIDS. AIDS however was not the reason why he desperately wanted to see Lester, it was regarding the cancer that so often accompanies AIDS. This man has been to 3 hospitals and pharmacies trying to get his prescription filled and St. Anne’s was his last option.
Lester’s calming approach settled the man and he went on to explain the medicine that he is looking for is currently reserved for approximately 40 of his clients who are in various stages of the disease and in much pain. He also indicated that he has limited supply of the drug and will run out this week. He asked if the patient was in pain to which he replied no. Lester explained how the cancer will progress and indicated that exercise (walking) was a good treatment for as long as possible. He went on to encourage the patient to return next week to see if his supply of Vankristin was restocked in the pharmacy. He also indicated that when he can begin administering the drug he would immediately registered him as one of his 140 palliative care clients.
Later I joined Lester at the HIV clinic where it seemed that he was interviewing and prescribing prescriptions to and endless stream of patients. For that hour Lester consulted with approximately 15 patients, had 3 interruptions and dealt with 1 pregnant patient who needed and immediate ultra sound - which we did without any assistance on the other side of the hospital.
The first patient was a 25 year old male with chest irritations, then a young woman in her 30’s followed by a young mother caring a child and HIV reports for both. Later, older clients came into his office, men and women between the ages of 50 and 60. One lady jokingly asked how long she had been coming for treatment. After Lester consulted her charts which are carried by the individual patients, said 2005. This made me realize that these drugs and programs are making a real difference in the lives of people, their families and communities.
That afternoon Lester, two nurses and I went to a regional hospital “Kapriri Health Centre” that was being given a Bicycle Ambulance donated by WUSC funded partially through donations from the CMF. The 4 of us were presented to the Head Chief of 7 villages, as well as the 7 village's Headman and approximately 30 village volunteers. Long speeches were given by everyone including Lester on how much the ambulance means to the villages and how many of the worries shouldered by the chief and his head village men have been taken away by this gift. Many thanks were given. The hospital and Lester asked me to make the formal presentation to the dignitaries. While not as long as the others, it certainly had its share of emotions and lively hand gestures, at least that’s what the translation looked like to me:-))
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