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

Tablets

1. Amoxyl
2. Ampicillin
3. Penicillin VK
4. Cotrimoxazole
5. Trimethoprim
6. Chloramphenicol
7. Ciprofloxacin
8. Cloxacillin
9. Cephalexin
10. Cefuroxume
11. Metronidazole
12. Multivitamins
13. Iron with ferrous sulphide
14. Paracetamol
15. Aspirin
16. Brufen
17. Indocid
18. Diclofenac
19. Morphine
20. Pethidine
21. Nitrofurantoin
22. Erythromycin
23. Metochlopromide
24. Phenobarbitone
25. Buscopan
26. Bisachudyl
27. Cocodamol
28. Magnesium trisilicate
29. Cimetidine
30. Ranitidine
31. Omeprazole
32. Lansoprazole
33. Diflucan
34. Acyclovir
35. Griseofulvin
36. Ascorbic acid
37. Propranolol
38. Hydrochlorothiazide
39. Methyldopa
40. Nifedipine
41. Allopurinol
42. Frusemide
43. Atenolol
44. Glibenclamide
45. Tolbutamide
46. Prednisolone
47. Hydrocortisone
48. Ketoconazole
49. Griseofulvin
50. Ergometrine Tablets
51. Piriton
52. Promethazine
53. Quinine

Injectables

1. Benzyl penicillin
2. Gentamicin
3. Benzathine Penicillin
4. Ampicillin
5. Chloramphenicol
6. Cefriaxone
7. Diazepam
8. Phenobarbitone
9. Diclofenac
10. Metronidazole
11. Lignocaine
12. Ketamine
13. Atropine
14. Pethidine
15. Morphine
16. Dexamethasone
17. Aminophylline
18. Dextrose 50%
19. Frusemide
20. Metoclopramide
21. Buscopan
22. Ergometrine

Ointments and creams

1. Dexamethasone eye/ear ointment
2. Chloramphenicol
3. Gentamycin
4. Gorofloxacin
5. Silver sulphadiazine
6. Any antibacterial cream
7. Mouth wash liquids
8. Acyclovir
9. Any antifungal cream
10. Any steroid cream
11. Any cream for burns patients
12. Atropine eyedrops
13. Any eye anaesthesia

Injectables

1. Any cough syrup
2. Any nose decongestant
3. Amoxyl syrup
4. Ampicillin syrup
5. Erothromycin syrup
6. Penicillin syrup
7. Metronidazole syrup
8. Paracetamol syrup
9. Mutlivitamin syrup
10. Iron syrup
11. Brufen syrup
12. Quinine
13. Nystatin
14. Promethazine
15. Salbutamol
16. Cotrimoxazole
17. Flucanozole

Other items

1. Nebulizer salbutamol
2. Assorted dressings
3. Splints
4. Antibiotic powder
5. Nebulizer machine
6. Suction machine for asthma patients

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

In a country where it does not usually rain between March and November any extension of facilities and staffing means a greater demand for water, and consequently we aim to drill more bore-holes and generally enhance the water supply network on site.

As the hospital grows and its facilities improve, so it is necessary to emply more staff; as more staff are employed, so more accommodation is needed; and since accommodation is simply not available for rent, that means Medic Malawi needs to build more houses – a continuing drain on resources.

The current development plan envisages further enhancement of the medical laboratory, construction of staff housing, building of a separate administrative block, setting up of a dedicated HIV/AIDS unit, setting up of a dental unit and improved transport system both for outreach clinics and to respond to emergencies. Improved water supply system and auxiliary power generation are also high priorities.