Newsletter: September 2006
September 25, 2006 by Vicky
The Operating Theatre
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
Newsletter: February 2006
February 1, 2006 by Vicky
Looking ahead, we fear that prospects for a reasonable harvest this year are not good. The growing season began well in December last with adequate rain, but by the end of January there had been no rain for three weeks and crops were beginning to dry out. Without significant rainfall in early February there will be further food shortages later in the year.
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.
Newsletter: August 2005
August 1, 2005 by Vicky
The Staff at the Hospital now numbers 43, with the prospect of an increase in staffing this month, if the Malawi Government implements its promised review of establishments in Rural Health Centres.
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.
From an email dated Feb 2005
February 25, 2005 by Vicky
“Today all wards are full. In the Paediatric Ward, each bed has two children and others are lying on the floor. In General ward, others too are lying on the floor. There is congestion. Increasing numbers are coming for tooth extraction.
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.
Newsletter: September 2004
September 1, 2004 by Vicky
St. Andrew’s Hospital, now officially designated a Rural Health Centre, goes from strength to strength. The Outpatients’ Dept. is treating between 40 and 70 patients a day, mainly for malaria, diarrhoea, pneumonia, accidents and an increasing number for meningitis. Admissions are running at 3 to 4 a day, usually with serious conditions of the above ailments, but also with upper respiratory infections. Many young children are admitted with severe anaemia.
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.