Saturday, July 26, 2008

First impressions of Embangweni

1 July, 2008, Monday

Where to begin? Chapel had already begun by the time we arrived at 7:05 AM. Mostly in Tumbuku. Some scripture reading, some extemporaneous exegesis by the sounds of it, a choral selection, sharing of concerns, announcements, a hymn and a benediction.

The Embangweni Mission hospital compound consists of several dozen terracotta-brick buildings and outer buildings surrounded by a terracotta-brick wall. Although the staff have told the community they need to keep the chickens out, there always seem to be a few hens clucking about on the grounds.

Officially, the catchment area is 100,000 people. Unofficially it's closer to 150,000.

Currently, Embangweni has about 130 beds plus mats for about 60 expectant mothers. Each inpatient, however, is typically accompanied by at least one and often two or three relatives. On average, the hospital has about 4500 to 5000 inpatient admissions each year and three times as many outpatient visits. That's not counting all the folks seen by the health centers and the mobile clinics.

Being admitted to a hospital alone is practically unheard of. For one thing, there is no facility to serve meals, so relatives bring food and water (there is a bore hole on the compound). Nurses hand over pills to each patient's caregiver or guardian and watch as the medicine is swallowed with water drawn by the caregiver. As odd as the system seems, it works. Given the personnel shortage, it would be criminal to try to keep friends and relatives out.

Its hospital policy to let one guardian sleep on the floor next to each patient. Others sleep outside the compound in the guardian shelter. Moms sleep with their children in the beds on the pediatric ward. Children six and up are admitted to the adult wards—which isn't ideal and the Embangweni staff know it. There are plans for a new ward for kids 6-to-13 years old—provided funding comes through, etc.

There are four main wards--female ward, male ward, pediatric ward and maternity—and the operating theater which is centrally located. At first glance, the wards seem practically deserted. In fact, everyone—family, friends and patients—are outside on the grounds, enjoying the winter sun. Only the very sickest remain inside.

In total, there are about 200 staff members employed by the hospital, including maintenance crews, laundry teams, drivers, ward maids, data clerks, the accounting team, nurses, clinical officers (sort of like physicians assistants or nurse practitioners), one physician, one matron and one hospital administrator.

Embangweni is a mission hospital—part of the Church Health Association of Malawi, which provides about 40% of Malawi's health care. There is one missionary here from the U.S.—Martha Sommers, who is a family physician—but she is not in charge. That is the job of the medical officer in charge. Right now Smith Mpepo, a clinical officer, is the acting officer in charge. The hospital is hoping a more permanent medical officer in charge will be arriving soon.

As for the rest, Mrs. Kamanga is the hospital administrator. She seems quite formidable—which is important when you're trying to prise amoxicillin or other drugs out of the government's Central Medical Stores. But she also has a wonderful laugh and a generous heart.

Am struck by the enormous size of the trees all around the compound. Some are 80-to-100 feet tall and look for all the world like the live oaks around the Rice campus in Houston. Several 10-to12 foot tall red and white poinsettias here and there and some enormous bougainvillea. Mango trees line several alleys. Not the sort of thing I had expected to see. But speaks to the generations of women and men that have invested in this place. Begun as a dispensary in 1902. Became a rural hospital in 1926.
Reminded me of something I heard from Leon Kintaudi, who was named one of TIME's Global Health heroes in 2005. We were talking about time frames—five-year programs and the like. He argued for a much longer horizon. You have to do things now in order to make a difference 100 years from now, he said.

(NB: This post was written on site in rural northern Malawi and posted now that I again have internet access.)


Lear said...

My church in New York supports the hospital at Embangaweni, but I am trying to identify a specific need of that hospital. Any advice on how I can find that out?

Christine Gorman said...

Start by talking to them directly, meeting with others who have been to Embangweni. Just like any other institution, Embangweni has a project list of things they are working on/hope to launch. These days with e-mail and Skype it's not that expensive to be in touch.

Lear said...

Thank you for responding. I have made all sorts of efforts to reach the hospital directly, but no luck so far. I did just get an e-mail address but I understand that all e-mails go through a HAM radio in South Africa. This is my first foray into trying to learn about a country as poor as Malawi and I have been really taken back by the difficulties. My daughter is studyig global health at Wharton(and will be completing her medical studies for the next two years at UCONN) and she tells me this is not unusual. I was really so naive as I truly thought our country was donating so much money. I am trying to fill a deep void in my education so that I can energize my small church and town to do more for those living in extreme poverty. Thankfully, people like you have responded and that is a big step forward.

richard Nhlane said...

iam richard Nhlane a first year Bachelor of medicine and surgery MBBS student at the university of malawi's college of medicine.I will be joining EMBANGWENI hospital or its sister EKWENDENI HOSPITAL once i finish my MBBS since its my home and am also a presbyterian, i thank you people for telling the world what exactly is happening in malawi's areas like Embangweni.