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
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