24 Sep Medic in Malawi
Field news from a volunteer medical student working in Mutunthama, Malawi.
With a rare five-month summer looming (due to the term dates of my intercalated year – rather than a generous gift from our medical school!) I started to hunt for a small medical charity in Africa where I could do some volunteer work over the summer. Medic Malawi, a UK-run charity which has built and continues to run a small rural hospital in Malawi, seemed an ideal destination.
After the many months I spent in East Africa over the past few years, landing in Malawi and navigating the endless red dusty roads, weaving past red brick huts, colourful towns and women wearing traditional Africa cloth (called Chitenge in Malawi) felt almost like returning home. Malawi has long been known as the ‘warm heart of Africa’ and despite its crippling poverty, its kindness and generosity towards visitors is immediately felt – perhaps just one reason why Malawi is such a popular elective destination.
St. Andrews Hospital is found at the edge of the community of Mthunthama, and provides medical care for up to thousands of the occupants of nearby villages. It is a well-built hospital – complete with an outpatient department, female, male, paediatric and surgical wards, a laboratory, ART clinic building and much more. All the staff at the hospital are Malawian and although there were no trained doctors on-site, the clinical officers, who had completed three years of clinical training, ran the hospital with much dedication and experience.
The four weeks I spent at St. Andrews taught me more about clinical medicine than one would learn in a year at medical school. I hit the ground running, assisting with a normal delivery, C-section and two miscarriages just in my first day at the hospital. The staff were hugely experienced in the management of HIV and malaria and we learnt much about the management of these conditions so rarely encountered in the UK. Much less was known about the conditions more common in the West such as heart failure, hypertension and diabetes, thus we were able to assist in the management of these patients.
Working in St. Andrews proved a striking contrast to my experience of medicine in the UK, which is becoming increasingly specialised. In Malawi the clinical officer would perform the role of a general practitioner, nurse specialist, pharmacist, consultant obstetrician, general surgeon and respiratory consultant all in the course of one morning.
Such a varied case load taught me about conditions ranging from molar pregnancy to emergency management of the newborn, from managing the side effect of anti-retrovirals for HIV positive patients to the surgical management of enormous abscesses.
In addition to the wide range of clinical cases, I was also forced to deal with practicing medicine in a low-resource environment.
Managing diabetic emergencies with no insulin and acute chest pain with no GTN was extremely difficult. While fantastic work is being done by the staff at St. Andrews Hospital, much effort is still needed in the Malawian healthcare system to improve care for patients.
With the other volunteers we created public health information posters for the waiting room, in both English and the local language of Chechewa, to increase patient awareness of the most important health topics such as HIV, Malaria and TB.
We also made patient information blackboards for each of the wards, with columns for 3-hourly nursing checks to highlight the importance of regular nursing care and make it easier to integrate patient information.
The death of some of the babies and children we were caring for was harrowing for the families and extremely difficult for us to deal with. If our patients had been born in the UK instead and had access to NHS hospital care, their lives would undoubtedly have been saved.
Malnourishment was a lethal condition – a feeding centre operating next to the hospital offered a lifeline to hundreds of families, but some were unable to afford even the transport to the facility.
In addition to poverty, the belief in herbal medicine and the witch doctor had a huge impact on the community.
Unsurprisingly, rubbing plant matter onto cuts often did not cure the patients so they presented to hospital as a last resort.
Newborn tetanus due to soil and plant matter rubbed into the umbilical stump is just one example of the dangerous complications of tribal medicine. Education is key to empowering patients in Malawi and avoiding preventable deaths.
Through this volunteering experience, I have learnt huge amounts about clinical medicine and the vast complexity of delivering healthcare in the Third World.
Medic Malawi’s St. Andrews Hospital is doing a remarkable job in a tough environment and it was a privilege to work there. My time in Malawi has made me more passionate than ever to work for MSF in developing countries in the future.
4th year medical student intercalating in International Health
University of Birmingham