We are working closely with Kasungu General Hospital to share skills and facilities, especially in the operating theatre. The surgical ward is now in use. The number of consulting rooms has been doubled by modifying existing facilities. The HIV/AIDS centre is open and serving the whole of Kasungu East with ARV drugs provided by the government. A new Guardian Shelter was funded and completed in July 2009 by students from Sedbergh School in Cumbria. Other schools which visited during the last summer break were St Peter’s School, Exeter who worked mainly with the secondary school but also built a classroom for Mtunthama primary school, Monkseaton School (Tyne & Wear) who decorated the primary school, and Wrekin College who again worked with the Orphanage. Our anaesthetist completed her training at the end of July 2009; other clinical staff have been on refresher courses. The dental unit has had some problems in terms of recruiting suitable staff, as dental therapists are in such short supply that they demand salaries out of proportion to the rest of the clinical team. We anticipate that a suitable candidate will soon be found.

Two English doctors arrived at St Andrew’s in October last, and after a six week compulsory familiarisation programme at Kasungu Hospital (the nearest government hospital), they worked as volunteers at St Andrew’s until February 2010. Not only were they of enormous value as clinicians, but they were also able to provide significant training for existing staff as well as develop improved systems in the Under-5 clinic. We are indeed grateful to them for all they have done, and hope that they will be the first of many young doctors who will offer their services in this way.

An encouraging comment received from them:

Things are OK at St Andrews – last week the oxygen machine and saturation monitor arrived. We are organising emergency equipment so that it is where it is most likely to be needed. The clinicians are in the process of setting up triage for children so the sickest are seen first. We would be keen to see if we could set up an under 5 clinic perhaps with the nutrition centre being involved. There is already a vaccination service so it shouldn’t be difficult (or need any more resources) to expand that to incorporate checking for malnutrition so that the kids can get followed up and given likuni phala[ a maize porridge] etc before they start failing badly. You must be pleased with what you have achieved at St Andrews. Obviously resources are limited but what they have is being used appropriately and the staff are keen to provide the best service they can.

We have recently been offered a donation to pay for installation of solar power in part of the hospital and expect work to start in the next few weeks. We hope that we shall be able to extend this in due course to cover the whole of the hospital, and later the orphanage.

We are currently making arrangements for a nurse volunteer who will spend some time at St Andrew’s in June 2010, and a nurse from Canada who has long supported Medic Malawi, intends to be there in August 2010.

One of the hospital wards

Two English dentists with their family are planning to spend some time in July 2010 running training courses at St Andrew’s for Medical Officers in the Mtunthama region, and to take out a mobile dental unit which they have funded, in order to provide “front line” dental treatment in the outreach clinics.

A fourth year medical student from Oxford chose to spend her Medical Elective in Mtunthama, and sent us this report:

We arrived in Malawi in a deluge, the streets literally turned to rivers. After a brief moment of panic at passport control when we could not remember the name of the village we were staying in, the short sprint from the terminal to the car left us soaked through. However as we were wondering what we had let ourselves in for on the potholed drive north, the skies cleared, and by the time we arrived in Mtunthama the sun was shining from a blue sky.

I had known for a long time that I wanted to visit Malawi, because people who went there always seemed to come back gripped by the country and its people. The elective period of my final year at medical school was the perfect opportunity, and so another student and I found ourselves heading to St Andrew’s Hospital.

The hospital staff gave us a friendly welcome, and we quickly got involved. The hospital has around 25 inpatients, and sees 50 – 100 outpatients per day, who arrive throughout the morning and queue in the heat on wooden benches. The operating theatre is also just about to open.[now open] The majority of patients are children under 5 with malaria or malnutrition, neither of which we had seen in the UK, but the clinical officers (who have a shortened medical training) are real experts in these common conditions and swiftly taught us the basics. We found that we had knowledge we could share with them too about conditions common at home but new in Malawi, such as high blood pressure and diabetes.

The hospital has very few resources by UK standards and has to cope with the challenging infrastructure of Malawi; during the frequent power cuts no blood tests can be done, and at one point a malaria tablet ran out because it could not be supplied from the regional hospital. The population is desperately poor and we found it difficult when patients couldn’t afford to pay for tests and medications that they needed. However the hospital undoubtedly saves many lives, and the dedication of the nurses and clinical officers is impressive. It was incredibly rewarding to see children who had been brought in unconscious with malaria or meningitis going home a few days later alert and smiling.

Outside the hospital we felt welcomed by the community, and stayed in a small house near the hospital where we got a taste of everyday life: candles at the ready for power cuts, food that tasted a little smoky from being cooked on a wood fire, a pop song played everywhere that celebrates the maize harvest. We loved meeting Florence and Boyson, who continue to pour out love to their many children at the orphanage, and gave some talks on HIV at the secondary school.

Five weeks flew by, and I came home with appreciation for what I had learned and very aware of how lucky we are in the UK. I hope to be able to go back to Malawi in the future, and in the meantime the community there continues to be very much in my thoughts and prayers.
Since her return to UK she has spoken to the congregation at her church about her experiences in Mtunthama, as a result of which several people have generously sponsored children at both primary and secondary schools.

Orphanage

The Orphanage now has over 60 children. Nearly all are resident, but a few live with local families. Those families taking orphans into their own homes are not paid, but they do receive some clothes for the children, and we arrange for them to receive maize on a regular basis. It is immensely encouraging to know that local people take food from their own supplies – maize or vegetables – to AMAO to help out. All Saints’ Church has given all its maize, which should strictly go to the Diocese, to feed the children.

Some children in the orphanage

In the Orphanage at present are 9 babies. The cost of formula milk for them is £350 a month. We calculate that the basic costs of providing food, soap, water, electricity and firewood for the orphans are in the region of £18,000 a year. Clothes, shoes, school fees and uniform are on top of that, of course. A system was set up whereby sponsors “buy” a day’s protein for children in AMAO, the orphanage. Many chose a birthday or similarly significant date as “their day”.

The garden at AMAO is productive, providing vegetables for the children. This is looked after by a gardener who is assisted by some of the older boys. The older girls continue to do a great deal of work looking after the younger children and helping with the cooking and washing.

The vegetable garden

Education

Now over one hundred needy children are being sponsored through school, giving them an opportunity they would not otherwise have had. Education is the key to escaping dependence on the vagaries of weather and uncertain harvests, and probably more than any other single factor can change lives for the better. It is encouraging to report that the primary school achieved the best results in final exams in five out of the six districts, and the secondary school gained the best results at MSCE (GCSE equivalent) in Kasungu district, with nine students gaining automatic entry to university.

Anniversary

1st August 2011 will be the tenth anniversary of the opening of what was then a small, local clinic. St Andrew’s has grown almost beyond recognition in that time, expanding and adding new projects every year. Such growth is in no small part a result of the generous support of so many who joined the “100 Club” when it was first set up, and of many others who have “come on board” during the years since St Andrew’s first opened its doors to patients. We have been extremely fortunate also in having a number of major donors who have responded to appeals for specific projects such as the building of the orphanage, the operating theatre, a new guardian shelter, and this year the start of the installation of solar power.

We have been blessed, too, by a dedicated and professional staff who often work significantly longer hours than their contracts require. Many of them have been loyal servants of the hospital, a few having been with us since the very beginning.

You may be interested to note how funding has been spent over the last few years, and how the constant expansion and developments have required increased funding, virtually year on year.

Figures are rounded to nearest £100.

For details on how to make a donation please click here.

We are proposing to celebrate the occasion of the tenth anniversary by a ceremony of some sort on Saturday 30 July, 2011. Anyone who is interested, without commitment at this stage, in knowing more about the proposed celebration and in joining a group to go to Mtunthama for about ten days/ a fortnight in the last two weeks of July, please let us know and we shall add your name to a mailing list when further details become available.
Thank you to all of you who help Medic Malawi to make a difference to the lives of so many people.

Ambuye ukhale nanu
Dot and Mac Forsyth

The Ministry of Health is funding the training of our clinicians in ARV management, and St Andrew’s will be the principal HIV/AIDS centre in Kasungu East district. Generally the hospital is seeing an ever-increasing number of patients. St Andrew’s is also set to become the Kasungu East centre for all but the most complex surgical procedures, working closely with Kasungu General Hospital. Future plans include enhanced water supplies, enhanced electrical supplies through the use of additional generators, ideally solar power/water heating, additional wards and an administration block as funding becomes available.

Gemma Barrow, a medical student, spent 6 weeks at St Andrew’s. She writes:

I did learn such a lot. I learned how to prescribe drugs that aren’t routinely used; how to practise real clinical medicine where a diagnosis isn’t solely made on the basis of test results as the tests aren’t available. When I arrived the Hospital did not have the reagents to test blood levels; about half way through my stay we received the equipment which made a big difference. I’ve left part of my heart in the village and I can’t wait to return sometime in the future.

School Visits

During our summer break there will be 4 school groups going to Mtunthama. Sedbergh School from Cumbria have sponsored the building of a much-needed Guardian Shelter, and during their visit will decorate the whole of the interior.

This is the kitchen area of the new Guardian Shelter, also to be decorated by the Sedbergh students. The tree stump will grow again, providing shade on hot days.

Monkseaton School from Tyne and Wear will be busy decorating the Primary School; St Peter’s School, Exeter will work with All Saints’ Secondary School and build a classroom for the nearby government primary school; and Wrekin College will again spend most of their time decorating AMAO (the orphanage). They have also funded the purchase of a vehicle to be used as an ambulance, and 2 of their staff will drive it from Johannesburg to Mtunthama – quite an adventure in itself! In addition to the work they will carry out, there is no doubt that all the UK students will enjoy time spent getting to know a different culture and sharing activities with their peers in the schools and orphanage.

A parachute sent to AMAO by Noah’s Ark, a children’s group at St Andrew’s Church, Plymouth, proved to be a massive hit. The visiting students from UK will certainly be dragged in to play!

AMAO, the orphanage

AMAO, the orphanage, has forty two resident children, 9 children cared for by adoptive families and 2 who somehow manage to divide their time very happily between adoptive families and AMAO! Florence and Boyson who have run AMAO since it began, without pay and without even a room to themselves, now have a small room of their own. When we said we would get 2 beds for them their immediate response was that 3 were needed, because all the babies would be sleeping in the room with them!

There is a great deal of help provided by the local community, quite apart from those who have adopted children. All Saints’ Church gave all its maize, originally earmarked for the Diocese, to the orphange, any electrical or plumbing work is done without charge by local tradesmen, volunteers drop in to help on a regular basis, and people turn up unannounced with small gifts of maize or vegetables to help feed the children. The older children do all their own washing, and are responsible for other tasks such as looking after little ones, cooking, chopping firewood for the kitchen and so on. The Mothers’ Union has cleaned the whole of the interior, including washing down all the walls. AMAO is a wonderfully happy place.

Because there are 9 babies, large amounts of formula milk are required, the cost of which is a major drain on resources. We would love to be able to offer the children a better diet with more protein, but that depends, as everything, on funding.

This little girl came to AMAO after her mother died in childbirth. As the mother’s name was Joyce, it was decided to call the baby Rejoice. She is now 2 years old, and seldom to be seen without a drink of milk.

Isaac, Grace and Henry from AMAO

Primary School

The Primary School now has 137 pupils, of whom 60 are sponsored by people in UK, All Saints’ Secondary School has 285 students of whom 45 are sponsored. The secondary school is completing the building of a science laboratory which will be a great asset. St Faith’s Kindergarten continues to provide care, food and basic teaching to some sixty children.

It is perhaps salutary to see a classroom – and remember that not all primary schools in Malawi have classrooms even as good as this. The bricks on the dirt floor are seats for the children. The cost of sponsoring a child at secondary school is £40 a year, and at primary £50 a year. There are always more children in need of sponsorship than there are sponsors.

Thank you all for your continuing support.

With your help, Medic Malawi really is

MAKING A DIFFERENCE

God bless you all.
Dot and Mac Forsyth

The Nutrition Rehabilitation Unit (NRU)

At this time of year the NRU is almost empty, as the recent harvest has provided sufficient food for the time being and the horrors of malnutrition are less evident. Increasingly we receive support for this work with the Under-5’s from a number of NGO’s such as Action Against Hunger, and this enables us to direct some additional funding to the orphanage. Consequently we have been able to purchase a supply of maize which should last certainly until April, and to leave sufficient funding to purchase “relish” (whatever is eaten with the nsima – a kind of mash made from maize) through to the end of April as well.

At current prices, it costs £12 a day for the 32 children in the orphanage for food, water and electricity. The AMAO weekly main meal menu is:

Monday: nsima, soya, vegetables

Tuesday :nsima, fish, vegetables

Wednesday: rice, meat, vegetables

Thursday: nsima, fish, vegetables

Friday: nsima, eggs, vegetables

Saturday : rice, beans, vegetables

Sunday: nsima, meat, vegetables

This looks quite reasonable until you realise that sometimes there has not been enough money to buy the necessary food, and that meat can mean ONE or at best TWO chickens between all 32 children! Fortunately the funding we have left should solve such problems for the immediate future. Inevitably the cost of maize will go up; today’s price is in the region of MK3000(£10.50) for 100kg, enough to provide the nsima only – no relish – for a family of five for one month. Set that against the income of the poorer families at MK4200/month (£14.70) and the perspective of poverty perhaps becomes clearer. It is so pleasing to know that with the help of all our supporters in UK Medic Malawi really is making a difference in these people’s lives.

Hospital News

The work of the Hospital continues to be immensely encouraging. The Dental Unit is fully functioning for the moment, though we have had problems in staffing it because a dental technician can virtually set his own salary, which is more than we are willing to pay because of the knock-on effect on the rest of the clinical staff in terms of both cost and morale. We are optimistic that we have now found someone who will be happy to work at St Andrew’s. The surgical ward should be completed by the end of October. We have a member of staff undergoing training in Blantyre to become an anaesthetist, and she has signed a legal bond tying her to the Hospital for at least five years after she qualifies. (Anaesthetists, too, are in short supply.) We were very fortunate to have a consultant anaesthetist with one of our groups of volunteers, and he was able with additional volunteer help, to do an invaluable assessment of medical stores and equipment, and to advise on the additional equipment we shall require when the operating theatre comes “on-line” next year.

Our new Administrator, Mr Aubrey Wande, has persuaded the Global AIDS Interfaith Alliance to donate an anaesthesia machine.

We shall shortly be publishing on the website a ‘shopping list’ of equipment we shall need for the Operating Theatre, in the hope that other organisations may also wish to offer similar help.

HIV/AIDS Centre

Work with HIV/AIDS patients is developing. We have two fully qualified HIV/AIDS counsellors, and anticipate the training of all clinical staff before Christmas. St Andrew’s will become over the next two months the HIV/AIDS centre for the whole area, with backing from the Ministry of Health and the consequent supply of free ARV drugs.

A group of young people living near the Hospital have set up a Youth Fellowship AIDS Club. They write and perform their own songs, poems and plays, and take them to the outlying villages as a means of educating about HIV, its causes, consequences and treatment.

The members of the HIV/AIDS Youth Club

This kind of self-help is at the very heart of the philosophy of Medic Malawi, that our role is to empower people to take responsibility for their own lives, and to work together to improve them.

Outreach Clinics

We have just purchased an additional second-hand vehicle to enhance the work of our outreach clinics for general medicine as well as HIV/AIDS work, thus enabling us to increase the number of outreach clinics and to provide a better follow-up for children discharged from the NRU. Outreach clinics are a great demand on staff time, as a clinical officer, a nurse/midwife, a homecare worker a dental worker and a driver are the minimum staffing needed for each clinic. How fortunate, then, that an anonymous donation in July of £10,000 enables us to proceed with the building of a pair of semi-detached houses for two more nurses. There is always a waiting list of nurses who wish to join the staff of St Andrew’s Hospital, and as quickly as we can build houses we can add to the medical staff.

We are blessed to have such a dedicated and enthusiastic staff at St Andrew’s, and to have so many volunteers willing to go out and use their talents in the service of needy people; and to have so many supporters here at home who donate money to enable all these wonderful developments to take place.

May God bless you all!

Dot and Mac Forsyth

NRU supplies

The Orphan House has doubled in size, and will be able to cater for about 50 orphan children; the laboratory now has a blood bank; there is a dedicated Voluntary Counselling and Testing room for HIV/AIDS patients; Dentaid will be sending out a refurbished Dental Surgery in the third week of September, and we already have staff who will be able to carry out dental procedures.

Florence and Boyson Kwaderanji, who look after the orphans

Group Visits

During July, three groups of young people from UK visited the campus to work on various projects.

Wrekin College from Shropshire paid a second visit in order to complete the second wing of the Orphan House. Quite apart from general support for Medic Malawi, they have made the orphans their special concern. This year they funded the construction of the second phase of the Orphan House, and built a kitchen to cater for 50-plus people. Additionally they started work on an irrigated garden to provide “relish” throughout the year, and made a play area for the children.

At the end of each day Florence and Boyson check all the children, a necessary precaution because they often find more children than they expect: other village children try to stay in the Orphan House rather than in their own homes!

St. Peter’s School, Exeter also paid a second visit. Whilst working with the NRU is one element of their activities – they livened up the NRU with some fun logos on the walls – they are most closely involved with the Secondary School. They have set up an internet link with the school, and have funded project work for the students of both schools to share their research. For example, they arranged for the All Saints’ students to spend time at the lakeshore studying geography topics, whilst the St. Peter’s students worked on similar research in Devon both groups were then able to share the information they had learned. St. Peter’s hope to arrange an exchange for teachers and students in the near future.

A group of young people from Islay spent some time in Mtunthama as part of an adventure activity under the auspices of Outlook Expeditions. They began the work of building a science lab for the Secondary School. There were two other groups from Outlook Expeditions at other locations in Malawi we hope that the All Saints’/St.Andrew’s campus will become a regular feature of their activities.

Foundations for the Science Laboratory

St Andrew’s Hospital

It is remarkable that only six years ago St. Andrew’s was a small rural clinic with only a dozen staff: it is now a Community Hospital with a staff of 58! Many of them have been with the project from the beginning, and one of the really encouraging things is the fact that so many have progressed by dint of training courses to upgrade their qualifications.

The schools have grown enormously in both numbers and buildings/facilities, the kindergarden goes from strength to strength whilst provision for orphans is improving all the time. It is good to see more and more volunteers choosing to spend time at one or other of the projects, and we aim to build a house over the next year or so to provide accommodation for them.

We noted that not only are health professionals from Kasungu General Hospital choosing St. Andrew’s, but also the maternity unit is becoming popular with the midwives from Lilongwe General Hospital to have their own babies! The MP for Kasungu East chooses St. Andrew’s for his family’s health care.

NRU

The NRU continues to be central to the work of Medic Malawi. Several NGO’s support the work, but their criteria are more rigorous than we would wish, in that children have to be seriously malnourished before they become eligible for help. As almost half of all children in Malawi are chronically malnourished, at St. Andrew’s we seek to provide food and health care to children before they reach the point of malnutrition which would attract help from the NGO’s. This means that we need to fund both feeding programmes and health care supplements. We are also hoping to increase the follow-up procedures once children are discharged, in order to ensure their ongoing treatment and support.

Carers with their children in the NRU. The smart, warm clothes the children are wearing were sent by well-wishers in UK. There is always a need for warm clothing for children.

Helping people to help themselves

It has always been the philosophy of Medic Malawi that the projects belong to the people of Mtunthama, that ultimately they must be responsible for managing and developing the work initiated by supporters here in UK. It is therefore especially encouraging to find an HIV/AIDS project in nearby Wimbe run entirely by volunteers, headed by Peter Minjale, one of our Clinical Officers. There is a team of 7 trained counsellors, each of whom has accepted responsibility for three villages, which he/she has undertaken to visit at least three times a week. Some of those villages involve a journey of 15kms each way. As there is no transport, they go on foot! We hope that we shall be able to send out some bicycles with the container due to go at the beginning of September.

The volunteers, and the building from which they work.

Another impressive project being run by local people is an agricultural cooperative. Having been provided with initial funding for seeds and fertiliser, they are now producing excellent crops for sale. The profits are used to purchase more seed and fertiliser, and to further develop the scheme. Those currently involved have their own bank account for the cooperative, and there is a waiting list of people wishing to join. The scheme does depend on a reliable water supply, and at present there are four locations adjacent to dambo areas (marshy land) in use, but the intention is to find and develop more such areas.

At the end of this month we are sending a container of goods and equipment to Mtunthama. This will include medical equipment, computers for both Hospital and Secondary School, books for both Primary and Secondary Schools, and of course the Land Rover/ambulance.

Our visit this year has been immensely encouraging. Not only are all the projects with which Medic Malawi is involved running successfully, but we gained a sense that the whole country is much more positive than previously. The harvest this year ranged from good to “bumper” and we can be optimistic that any food shortages will be relatively minor.

One final thing: the increasing number of young people visiting Mtuthama, either with groups or as individuals, is serving to build bridges and foster understanding across the divides of distance and cultures.

Ambuye akhale nanu!
May the Lord be with you!
Dot and Mac Forsyth

“While planning a visit to Zambia to see the projects we support there through ‘Operation Sunshine’ we thought it a good idea to see St. Andrew’s Clinic /Hospital in Malawi, and what a good idea it was – full of interest, facts, figures, work, wonderful people, sadness, laughter and joy.

This is an excellent hospital run and supported by exceptional people both in Malawi and England and elsewhere We saw the whole hospital: maternity unit soon to be enlarged and upgraded; the women’s ward with their small children with them— they have no where else to leave them; the HIV/Aids unit; the out patients and children’s ward—often two or even three children to a bed.

We worked in the pharmacy counting pills by hand, and cutting materials and rolling cotton wool balls for the dressings. Oh for a pill counter and some good scissors! We helped with the baby feeding programme for the wee malnourished babies needing help to stay alive, and their thin young mothers so quiet and dignified. We were told of the outreach project , keeping an eye on the little ones who have returned to their villages. We heard about the teaching of family planning – the women are keen but the men are not so!

One of the highlights was hearing the orphans singing for us; it was superb. I think the African has a different throat mechanism from the Westerner; the power and harmonisation of even a small child is incredible.

I spent time with Snowdean Njiwa the hospital administrator and learnt so much about Malawi, its politics, its peoples and customs, its problems and its joys, and of course about St Andrew’s and how this great project has evolved and is still evolving.

God’s hand is surely in all the planning and work with these lovely people—thank you Medic Malawi.” Felicity

School visits

In July two schools will be sending groups to Mtunthama. Wrekin College, Shropshire will complete the final stages of the new wing of the Orphan House, which they have fully funded, and St. Peter’s School, Exeter will be working in the schools. Both groups will also help in the Hospital and the Under-5 feeding programme. No doubt there will be plenty of sport and social contact, and the church services will be very special indeed, as both schools are already rehearsing their hymns/songs, and All Saints’ choirs will seek to be even more impressive than usual!

Dental Surgery

A complete Dental Surgery provided by Dentaid is about to be shipped out from UK, and plans are under way to send a container in September.

Hospital Equipment Shopping List

We would like to be able to include as much of the following as possible in the container going out at the beginning of September.

If you can help by donating anything from this list, please get in touch. Thank you.

• 8-10mls test tubes
• Adhesive plaster
• Anaesthesia machine and monitors (Pulsoximeter)
• Autoclave (110 litres)
• Biohard bins
• Caesarian section full set x 4
• Centrifuge (12 rotor)
• Chemistry Analyser (Liver function)
• Cimetidine
• Cotton wool
• Crepe bandages
• Crutches
• D & C
• Dental needles
• Dental syringes
• Diagnostic sets
• Digital scales (0-250g capacity)
• Dispensing bottles
• Drug trolleys
• Dry gauze
• Eusol
• Evacuation full set x 2
• Examination gloves
• Face masks
• Gallipots (various sizes)
• Gauze bandages
• Goggles
• Haematology analyser
• Hernia repair kit
• Kidneydishes (assorted sizes)
• Laparotomy
• Medical/Nursing books
• Nebulae machine
• Needles
• Office fans
• Office file trays
• Olympus microscope
• Operating Table
• Oxygen concentrators
• Paraffin gauze
• Patient screens
• Photocopier
• POP cutter
• Safety cabinet (fume hood)
• Savlon
• Sharps containers
• Sphygmomanometers
• Sterilisation drums
• Sterilisation pouches
• Stopping bottles
• Suction machine for newly born babies
• Surge protectors
• Surgical gloves
• Sutures
• Syringes
• Tablet cutters
• Theatre canvas
• Theatre Lamp (portable)
• Thermometers
• Toothbrushes
• Weighing scales (Kg)

The entrance to the new Operating Theatre, in the final stages of completion

It is really exciting news that the Operating Theatre will be in use very shortly thanks to a generous donation from Aspect Capital Ltd., a hedge fund management company in London. The building houses a large and light main theatre, a minor ops theatre, prep rooms, post op room, nurses’ room, clinicians’ room, showers and all necessary storage areas. The Theatre building is located adjacent to the labour ward/delivery rooms which, even though they are regarded as among the best in Malawi, will be upgraded in the next phase of development to give an additional delivery room. The need to enhance the maternity facility is a result of the popularity of St. Andrew’s Hospital and the campaign to persuade mothers to deliver at a Hospital, because statistically one in seven mothers in Malawi dies in childbirth. Patients are now coming to St. Andrew’s not only from Kasungu, 30 kms away, but also from Lilongwe, 130kms away, because of the quality of care they receive. And some of them are health professionals working in other medical centres!

The interior of the Main Theatre showing the large windows.

More exciting news is that St. Andrew’s, which opened in August 2001 as a small clinic, has been upgraded first to a Rural Health Centre and in August 2006 to a Community Hospital. As the Hospital grows so the demand for more Staff and therefore more houses grows. We are making application to various NGO’s for funding for several new projects. We want to build a post-operative ward with ICU and HDU facilities, an Administrative Block containing all administration offices, accounts, Staff Rest Rooms, (to date the Staff do not have anywhere to “switch off”) a Library, and a purpose built VCU (Voluntary Counselling and Testing Unit) for HIV/AIDS patients. We plan to open a Dental Unit as soon as the equipment becomes available – the room has already been set aside for such a development. Kyle Danielson from Canada has set a target of raising sufficient funds for a new 45-bed ward. Additional staff houses are required, as is a bore-hole to supply water to some of the staff houses. Thanks to South West Water and St.Peter’s School, Exeter, the Hospital has a new bore-hole as a stand-by should there ever be problems with the main water supply.

The new bore-hole for the Hospital

More Construction Work

We need also to construct a storage unit, a Guardian Shelter for those caring for patients, and to build a much larger NRU for the Under-5 programme. In mid-August the NRU had only two patients, but by mid-September the number had risen to nine. There is no doubt that over the next weeks that number will continue to increase as the food shortage resulting from very poor rains begins to take effect. The NRU/Under5 programme is the biggest in the whole of Central Region.

This child shows the swollen belly typical of Oedema (malnutrition)

We have been able to make significant purchases of maize while prices are low so that we now have a store of maize ready for the time when people have no food and no money to buy any. It is expected that there will be in the region of 90/100 children seeking help at the NRU by the middle of November. By that time it will be necessary to run an adult feeding programme, but again we have made provision in the purchase of maize while it is available and relatively inexpensive.

Maize bags being closed up after the addition of Actelic Dust to prevent weevil infestation. Each bag contains 100kgs of maize; we have 100 bags.

Staffing at St Andrew’s Hospital

You may like to have an idea of the staffing of the hospital. We currently employ:

two Clinical Officers;
one matron and one deputy matron, both of whom are Nurse/Midwife/Technicians;
four other Nurse/Midwife/Technicians;
one nurse;
one Medical Assistant who also does dental work;
one Lab Assistant;
one Pharmacy Assistant;
one Dental Aide;
one Patient Aide;
seven Ward Attendants;
four Homecraft Workers;
two Cleaners;
two Drivers;
one Laundry worker;
one Administrator;
one Accountant;
one Accounts Clerk;
one Cashier;
one Receptionist;
ten Watchmen/labourers;
and two Maize Mill Operatives.
We are advertising for a Clinical Officer Anaesthetist to start as soon as possible.
Also interesting is a guide to net monthly salaries – Matron: £82; Nurse/Midwife/Technician: £74; Lab Assistant: £31; Driver: £27; Cleaner: £13. And St. Andrew’s pays good salaries!

Set against salaries the cost of basic requirements: rent for a tiny two room house – £4; a month’s supply of maize – £2.00; a month’s supply of firewood to cook for a family of four – £2.00; soap for a family of four for a month – 60p. A farm worker employed on a local estate, after ten years (non-pensionable) service, receives £8.50 a month.

The Orphan House

The Orphan House now has 32 children living in it, and other orphans who are living with foster parents are fed every day. Fifty children are sponsored at the Primary School, 87 at the Secondary School, and the Kindergarten has 40 children, over half orphans, who are fed each day as part of the Kindergarten programme. Funds are now available to complete the second half of the Orphan House, so that we shall soon be able to accommodate another 30 or so youngsters.

Bunk beds and happy inmates at the Wrekin College Orphan House

Future Developments

In order to permit future developments, we have purchased a tract of land adjacent to the Hospital. It will obviously be quite some time before we can afford to build on that land, but in the meantime we hope to establish a drip-feed irrigation system which will enable the growing of two or even three crops a year, and which will also be a tremendous teaching aid in showing what can be done if water is available. Sustainability and self-help have always been at the core of all that we have sought to achieve through Medic Malawi, and such a project could prove immensely valuable over the next few years.

Prideaux Family Visit

In July the Prideaux family from Plymouth – two dentists and their three sons – visited St. Andrew’s. They set up a dental education programme, carried out many examinations, fillings and extractions, and prepared the way for us to apply for help from Dentaid, UK. Their two older sons helped in the Pharmacy and the Secondary School, the youngest one attended the Primary School. You can read their report here.

Finances

We do not usually write much about the detailed finances of St. Andrew’s in the Newsletters, but having given some idea of staff salaries and the cost of basic foodstuffs, we thought supporters might like a more precise indication of how the money raised in UK is actually spent on a month-by-month basis.

Salaries – £600 (CHAM now pays £1600)
Drugs/consumables – £1500
Outreach Clinic – £50
Fuel – £150
Maintenance – £100
Lab Facilities – £600
HIV Testing – £70
NRU – £400+
Electricity – £150
Water – £60
Telephone/Postage – £30
Insurance – £200
Maize Mill maintenance – £70
Orphans – £15
Registration fees – £5
Misc. – £250
In addition, there is the cost of all project work, such as buildings. We also endeavour to offer staff the opportunity to enhance their qualifications, provided that they undertake to continue working at St. Andrew’s after they have qualified.

Sometimes a reminder of why the work of Medic Malawi is so important may be useful. The following experience serves such a purpose.

“I asked the house boy this morning if he had a mosquito net. ‘They are too expensive,’ he replied. (They cost 25p.) Just imagine being so poor. But then he told me an even more heart- rending tale. Yesterday he had met a young boy aged about 13 in the market. The boy explained that last year both his parents had died, and that a week ago his older sister had run away. The boy himself had been thrown out of the house where he had been living by the village headman. The lad had nowhere to go, no-one to pay his school fees, no-one to give him food or shelter. Thankfully, with the Orphan House and the sponsors who support pupils at the Secondary School the boy now has a roof over his head, food to eat, a caring community and the chance to be educated.”

In the past we have not used the newsletter to ask for funding, but on this occasion we would like first of all to thank all those who contribute as members of the “100 Club”, for it is those donations which are the basic source of revenue for Medic Malawi, and to ask all supporters to consider whether or not they are in a position to increase the level of their support. Most people have submitted a Gift Aid Form which allows us to reclaim tax paid on eligible donations; if you have not done this please obtain a form from the web site or contact us direct. As you can see, the original target for the “100 Club” of 100 people each to donate £10 a month, thus raising a regular monthly income of £1000, now falls far short of what is needed. Are you in a position to increase your monthly support; or could you perhaps encourage friends to help by joining the “100 Club”? Please remember… every penny raised goes to Malawi.

May God bless you all.
Dot and Mac Forsyth
21 September 2006

Last year a group of students from Wrekin College, Shropshire, travelled out to Malawi to work on the new Orphan House for which they had already raised the building costs. As well as completing the interior decorating with bright, lively cartoon figures across the walls, many of them undertook a range of tasks within the hospital, such as in the laboratory and in the under-5 clinic. The orphan house now accommodates 21 residents and provides meals for many more who live with adoptive families in the village.

The new orphan house

For the last month Alice Dwyer, a medical student from University of Sydney, Australia, has been working as a volunteer at St. Andrew’s Hospital, as part of her Elective. We hope to have an account of her time in Mtunthama shortly, but have received glowing reports from hospital staff, including “Alice loves the little ones very much”. She has spent considerable time in the Under-5 unit.

Last year Kyle Danielson, from Canada, spent six weeks working as a volunteer at the hospital. He made an enormous contribution to the life and work of the hospital while he was there and this year he is planning to go again, this time accompanied by a group of nurses and possibly even a surgeon! Kyle has also, since his return to Canada, raised significant sums of money and sent valuable equipment out to St. Andrew’s. He is looking at the possibility of establishing Medic Malawi, Canada, as a charity in its own right.

Two experienced dentists from Plymouth, UK, plan to spend about three weeks at St Andrew’s Hospital during late June/early July. They will also spend some time in the Dental Unit at Kasungu General Hospital. This is the way they have chosen to celebrate their Silver Wedding!

Sally Symonds, an English lady resident in Australia, decided that she would celebrate her birthday lasat year by doing a sponsored sky-dive to raise funds for Medic Malawi. We are so grateful for the £1300 thus raised. And incidently, it was her 70th birthday she was celebrating!

In April this year a group of students, all girls, from St Peter’s School, Exeter, will be travelling to Malawi to work on a number of projects on the campus, including work in the Under-5 clinics and quite possibly with the orphans in the new Orphan House. We wish them a safe trip and hope they have an exciting time. We look forward to hearing their reports.

DFID has funded “top-up”allowances for Clinical Staff in an attempt to persuade them not to apply for posts in other countries where the financial rewards are so much higher. We are fortunate at St. Andrew’s in having a waiting list of applicants for Clinical posts.

Harvests this year have ranged from ‘poor’ to ‘very poor’, with the consequence that serious food shortage is inevitable within the next few months. Already the Nutritional Rehabilitation Unit for Under-5 children has 10 in-patients and 17 out-patients: at this time of year we would normally expect 2 or 3 in-patients. Ours is the only NRU in the District, and is training other health care workers in the management of chronic malnutrition. What was built as the Guardian Shelter for the Clinic is now completely taken over by the NRU, and so a new Guardian Shelter will have to be constructed. Malnutrition in children continues to be a major problem.

Over the last four months 120 under- fives were tested for anaemia: of those, 5 had normal haemoglobin levels, 43 had mild anaemia and 72 severe anaemia. Link those figures with 44% of under fives tested for malaria being positive, and you see just how vulnerable these children are.

In the ante-natal dept. there are integrated education programmes taking place every day – nutrition, baby care, family planning, HIV education. We currently have one Outreach Clinic which involves an 80 km round trip every month for a Clinical Officer, a nurse and a Health Care worker. We are in discussions with the District Health Officer to begin a second Outreach Clinic (this one only a 60 km round trip!). At these Clinics work is done in clinical, immunisation and health education spheres.

St. Andrew’s is also working with Government and NGO sources in the treatment of HIV/AIDS and other STI’s. Currently in Malawi there are estimated to be 170,000 patients in need of ARV drugs, but only sufficient medication this year for 35,000. We also now have access to free palliative care drugs such as morphine. A room in the Hospital is being refurbished as a VCR(Voluntary Counselling and Testing) centre whilst we wait for the result of an application to the Global Interfaith Programme for funding to develop a purpose-built centre. Local volunteers from the villages are being trained as counsellors.

The Maternity Unit goes from strength to strength. Increasingly expectant mothers are being persuaded to have their babies in hospital where proper care is available in the event of problems, and more and more they are staying in hospital for 48 hours after delivery.

One new baby weighed only 800grms at birth, but because she was born in hospital where she can be kept warm in an incubator, she will survive. Her twin sister weighed 1.2 kg., and is also progressing well.

Wrekin College in Shropshire funded the construction of an Orphan House which will eventually accommodate 32 children and their carers, as well as being a day-centre for many more local orphan children. The centre will provide a meal every day for all the needy orphan children in the Mtunthama area. A group of students from Wrekin spent a couple of weeks decorating the inside of the orphan house, as well as working at the hospital. In addition other young people from St.Andrew’s Church, Plymouth, and one volunteer nurse from Canada have spent time at the Hospital in July and August.

The current situation is immensely encouraging. A significant amount of maize has been purchased ready to respond to the expected food shortage; the Maternity Unit is delivering over 50 babies a month; the NRU is now providing a sophisticated and well-funded programme to counter some of the effects of chronic malnutrition in children; the orphan house will open this month; almost 100 children are being sponsored through school. Of course there are problems. In the cold weather there have been some very serious burns cases – all children; malaria and pneumonia are rife; malnutrition is an ongoing problem; and anti-malarial drugs, on sale cheaply in small shops throughout the country, are literally poisoning people as they contain dangerous chemicals.

The Operating Theatre in early August. Construction is now at lintel level, but we desperately need funding to complete the building. Once completed, this facility will make a huge difference to the range of procedures the Hospital will be able to carry out.

Looking ahead, our immediate aims are:

• to complete the building of the Operating Theatre;
• to achieve a purpose built VCT unit;
• to construct the necessary post-operative wards;
• to build a Dental Unit;
• to build a new Guardian Shelter to replace the one now used for NRU;
• to build the extra staff houses we need as staff numbers increase;
• to construct an administration block, releasing rooms in the Hospital for clinical work.

The “100 Club”, our main source of income, was set up to meet routine running costs; these have more than doubled as the Hospital has grown. Members of the “100 Club” make regular monthly contributions of £10 or more. If you could help in this way, please contact us.

Thank you all for your continuing support.

HIV/AIDS. St. Andrews is doing Voluntary Counselling and Testing. ARV drugs are being given to those who have had VCT and are infected. We have applied to Global Strategies for HIV Prevention for free Nevirapine drugs for pregnant mothers to prevent transmitting HIV to new-born babies.

Some other tests carried out in the Laboratory are: Haemoglobin, Malaria Parasites, Stool analysis, Urine analysis.

FOUNDATIONS. We have just started the Semi-detached house. There has been heavy rains that it was difficult to transport building materials to the site. We have submitted the Theatre plan to the Planners.

HOSPITAL ITEMS. The Ultra-Sound Scanner is functioning. Pregnant women etc are being scanned right here at St. Andrews Clinic. We are proud of it. We can see the hospital growing. God bless you people.

MR ST. ANDREWS CLINIC. An epileptic man, 55 years old, was burnt in a fire during a fit in 2001.He comes twice weekly to receive dressings to cover the wound on his heel. To date he has had some 700 dressings and used 2.1 kilometres of bandages. Finally he has agreed to have a skin graft done under local anaesthetic. By day 8 the skin will be cured. The name Mr St.Andrews comes after the usual coming to the Clinic twice weekly.

Mr. St. Andrew’s Clinic is on the left. He and his family are supported by a family at St.Andrew’s Church.

MANUAL VACCUM ASPIRATION. Japaigo(NGO) are going to train our staff on the MVA programme.

Your prayers are bringing the staff together. We preach about love and staff are trying hard to maintain good relationship with one another.Generally, there is peace within the staff members. May the good Lord be honoured.”

The Clinic is full; the guardian shelter has been completely taken over by the NRU and an alternative must be built; the Operating Theatre is an urgent priority; short-term housing for orphans is now a necessity. Whilst we have some funds for capital projects, the original 100 Club, set up to meet basic costs of medicines, consumables and salaries, can now fund only a proportion of those costs (for example growth in patient numbers and services offered requires more than twice the staff of two years ago). If you are not already a member of the “100 Club” and would like to support Medic Malawi in a regular way, do please contact us.

A Medical Assistant has been appointed. Not only is he able to diagnose and treat most illnesses, but he is also a Dental Technician; thus we are now able to offer some dental services to patients, which is a great step forward as there were no dental facilities in the Mtunthama area.

The Maternity Unit runs ante-natal clinics twice a week, with 50 to 70 expectant mothers attending each clinic, and deliveries are between 2 and 5 a day, though the current record is 8 babies born during just one night!

The NRU (Nutrition Rehabilitation Unit) is now the only Unit of its kind operating in the whole of the Kasungu District. Much help is coming from UNICEF, Action against Hunger, CHAM, and Norwegian Church Aid. Between them, these organisations are assisting with the provision of maize flour, cooking oil, milk, blankets, mosquito nets and some medical supplies. This of course takes some of the pressure off Medic Malawi and allows us to extend the programme. We now have two Homecraft workers who teach nutrition, hygiene, child care and so on. Once a week there is a “demonstration meal”. Mothers are taught about nutritious foods, their children are given a meal in the NRU, and then they take home with them sufficient food for the child(ren) for one well balanced meal each day for the next week. This not only ensures food for the child, but encourages the mothers to return the following week for the child(ren) to be checked and fed. Twice a week there are under-5 immunisation programmes in the fight against measles, polio and TB.

At the end of July we purchased a second ambulance, and this will allow us to set up Outreach Clinics. These clinics will operate once or twice a month, taking medical care to those living in areas where it would otherwise be unavailable. In addition, we hope to be able to establish effective follow-up programmes for children who have been discharged from the NRU.

The Medical Laboratory is now complete, and basic equipment has been purchased to allow for testing for malaria and bilharzia. As funds allow(!) the level of equipment will be improved enabling a higher level of quick and accurate diagnosis of a wider range of ailments. No longer will patients need to be referred to Kasungu Hospital for testing. This will save time and thus ensure more rapid treatment.

All the water supplied to the Hospital comes from the bore-hole which was sunk last year. The water is pumped to holding tanks from where it flows by gravity to the Hospital. This ensures a guaranteed supply of pure water, no matter what happens to the national grid. There have been problems, however, with the provision of a generator, and sadly we have had to take the contractor to court for breach of contract. We await the outcome of the case.
As yet we have not been able to obtain funding to build an Operating Theatre. This is, of course, a big project requiring something in the region of £25,000, as well as the costs of equipment. Currently, though the medical staff have all the skills to carry out surgical procedures they do not have the necessary facilities and so have to refer patients to Kasungu Hospital, which entails a road journey of 30 kilometres. Probably the most common surgical procedure would be Caesarean section, but many other procedures could be undertaken if only we had the facilities.
Education is the key to the future of Malawi. In purely health care terms, 40% of women who die in childbirth would survive if they delivered in Hospital. There is still a dependence upon the Traditional Birth Attendant in the villages, and in cases of haemorrhage, for example, by the time the problem is apparent it is too late to move the patient to Hospital, and so she dies. The family of a woman who was the victim of a stroke refused to allow her to be treated in St. Andrew’s on the grounds that her parents had suffered strokes and so members of the family must be fated to die in that way – the family insisted on taking her back to the village to die without treatment. A little girl bitten by a puff adder was taken to the witch doctor. Only after 12 days, when it was apparent that the witch doctor’s treatment was ineffectual, was the girl brought to St. Andrew’s. By that time the snake-bite had become infected, her foot was gangrenous and it was necessary to amputate three toes. Later she was transferred to Lilongwe Central Hospital where the rest of her foot was amputated. At least she survived. These examples emphasise the need to extend the health education programmes, and to take them out into the villages. We already have the work done by the Homecare workers; a demonstration garden to show people how to grow crops more effectively; we are assisting in an irrigation project to permit the growing of more than one crop of maize a year; the beginnings of the Outreach clinics and follow up programmes for the under-5 clinics; we aim to set up over the next twelve months a poultry unit for eggs and meat and a dairy goat unit which will serve both as a source of food and an agricultural training unit, so that people will learn how to make the most of these resources.

A Primary school has been established. The Government Primary School in Mtunthama has up to 100 children in each class (that is NOT a misprint!). The new school has no more than 10 children in each class, though this will of course increase, but the aim is to ensure real care for the children with quality teaching, and so class numbers will be limited. The fees are currently £45 a year. A number of the children are orphans, brought up by extended family or foster parents in the village and helped by the Mothers’ Union. By raising funds from their sewing/knitting projects , the Mothers’ Union subsidise the costs of bringing up the orphans, thus allowing them to grow up in a family environment. If you would like to sponsor a child at Primary School for £45 a year, please let us know.

The St. Faith’s Kindergarten is thriving, with about 40 children, half of whom are orphans, attending each day. They play, learn songs and rhymes in Chichewa and English, and are fed(!). A recent donation from a lady in Dawlish has bought toys, including a tricycle, paid for tea, milk and sugar for the children, and enabled the helpers to be paid. (They are meant to be paid a nominal sum, but whilst funds were not available they simply worked as volunteers.)
Increasingly people from UK are seeking to spend time at St. Andrew’s. All pay their own fares and living costs. One girl worked for three months in the NRU and Secondary School; a group of 11 young people went for a fortnight in July, working in the Hospital, the Secondary School and the Kindergarten, and during their time built a store for maize so that we have supplies ready for the onset of the inevitable food shortage later in the year. A Maths teacher has just returned from a month’s teaching. Another small group, including a trainee paediatric nurse, is there for about five weeks working in the Hospital, the school and the NRU.

What began as a relatively small project with about 10 staff in August 2001 is now a thriving Hospital unit with a staff of over 40, a programme for the care of orphans within the community, Primary and Secondary Schools and a Kindergarten. Costs increase, further expansion and development are essential to serve the community, but with your continued help Medic Malawi can go forward to meet those needs.
Thank you for your support.