“Are we winning here?” sounds the refrain of the English nephrologist at the bedside of a patient in Queen Elizabeth Central Hospital (QECH), Malawi. The path to success is anything but short and sweet.
Doctors working in Malawi face a number of difficulties in their practice. Most of these are due to a lack of financial and human resources. Financial resources limit the number of physicians that can be trained, as well as the the number and range of investiga- tions physicians can perform. Even when a diagnosis has been reached, physicians have to consider if the treatments they require are actually available at all. A poor population also leads to empty hospitals. It is
not because people are healthy, but because they simply cannot afford
the treatment. Human resources are also scanty and the responsibilities carried by each individual are often far higher than in the UK. The nephrologist on-duty was responsible for the entire medical ward, consulting patients well beyond the normal scope of his professional practice. Third-year medical students were responsible for clerking and monitoring bays full of people. The lack of doctors also mean that most district hospitals are run without any permanent doctors at all and are run instead by clinical officers.
Down in the hot plains in the south of the country where the Shire river flows, fishing provides many people’s livelihood. Lymphatic filariasis is common in these regions and the incidence of hydrocoeles is very high. Patients often do not present at hospital until their condition has reached a very advanced stage. This occurs because they aren’t aware of the fact that the condition is treatable, partly because public health programs in practice but tend to focus on HIV and malaria awareness.
Various non-governmental organisations try to help. The Red Cross provide malaria nets in many rural communities. But after handing out the nets, they have to return a few months later to check if they are being used properly since some nets have been found hung over chicken coops to keep predators at bay.
Misconceptions are also important considerations to tackle. As an example, many Malawian men believe that the use of malaria nets weakens them sexually. To encourage correct health practices, the Red Cross have found that using people from within the communities for peer-education projects tends to work better than using white volunteers or even other Malawians. The peer teachers are able to act as role models within the community and their advice is less likely to be perceived as paternalistic.
Healthcare provision tends to get worse the further you move from the city. In a poor country, Muona is at the end of a road to nowhere, the extension of the road through it has been washed away by a river. It wasn’t easy to get out of and we had to go twenty kilometres on the back of someone’s bike, then hitch a lift across a river in a fishing boat, and get another bicycle taxi back to a paved road where we were able to catch a minibus back to our lodge in Blantyre. Though this was an ex- cellent adventure for us, it presents a huge nightmare for anyone trying to get their produce to the market. As a result, economic activity is extremely low and Muona is astonishingly poor.
As no aid organisations have stepped up to help fill the deficit, Muona is peppered with half-constructed buildings started by donors who promised much but ran out of money or inclination to help before anything useful was achieved.
Signs of improvement are few and faltering, but they are extant. Dream is an Italian NGO staffed almost exclusively by African nationals. It works alongside the government to help prevent mother to child transmission of HIV and some of its research in Malawi has been used
to change WHO policy. The College of Medicine in Blantyre has been assisted by the University of St Andrews and aims to qualify around seventy doctors per year, an increase from the seven per year only a decade ago.
Are they winning? As there are multitudes of hurdles to overcome, such a question is hard to answer. Certainly HIV and malaria are huge challenges, compounded by a shortage of resources. However, doctors in Malawi just getting on with it, doing what they can and keeping their heads up. Their attitude and efforts are incredibly inspirational and cannot help but leave you with some hope.