A picture is developing of how much ground Malawi has lost in health care since the 1980s—post-structural development, post the explosion of the AIDS crisis. Talked with Dr. Peter Kazembe, who runs the Baylor Pediatric AIDS clinic at Kamuzu Central Hospital. He retired from the Ministry of Health but never left medicine.
Back in the 1980s, when Kazembe was director of the hospital, they had had enough reagents and skilled technicians in the lab that they could do the blood work to diagnose sickle cell anemia—a fairly common condition in this area. Nowadays, he said that is impossible.
Earlier in the day I spoke with Dr. Hadge Juma, the current director of the hospital, and Patricia Nkhoma, a registered nurse-midwife who supervises the surgical department. The main structure of the hospital facility was built in 1977 with 500 beds. Another part of the hospital located about six kilometers away contains the maternity and tuberculosis wards, has 250 beds and was built in the colonial era.
Yesterday the main campus had 970 patients.
More than 70% of hospital admissions are HIV-related Juma said. Twelve people died at the main hospital yesterday. By the time I arrived for a mid-afternoon appointment another 8 people had died. (And in fact, I glanced over at the morgue when I arrived and saw four private vehicles, waiting to claim bodies of relatives and loved ones. Bodies are usually prepared for burial by the families, I'm told. No one has money for embalming.)
Currently there are 202 nurses covering both campuses, Nkhoma said. Of that total, 43 are registered nurses. The complement should be 550 nurses. Since April, 17 nurses have resigned from Kamuzu Central--one to follow her husband overseas and most of the remaining ones left to work for Dae-Yang-Luke, a private hospital run by a Korean church that is opening up near the airport.
(Correction: July 30, 2008. According to Abigail Bonongwe, matron at Dae-Yang-Luke Hospital, only two nurses have come from Kamuzu Central. Indeed, DYL Hospital has made a concerted effort not to recruit nurses from government hospital, targeting those working at NGOs or just graduating from nursing school instead. Also DYL Hospital is not a private hospital but is part of the Christian Health Association of Malawi.)
This internal brain drain—out of the public sector and toward NGOs and private hospitals—is turning out to be every bit as important as the external brain drain.
Friday, June 27, 2008