Saturday, July 26, 2008

Sad News at Morning Report

14 July

Learned during morning report this morning that 12-year old Charity died at 3:30 this morning. She had cryptococcal meningitis and had been on anti-AIDS medication since February. First her father, then her mother died. She was admitted on June 24 and was responding to the meningitis medication but she also had chicken pox and Kaposi's and that's probably what overwhelmed her. Easy to believe that without her mother it was just harder for her to get proper care—particularly with the follow-through on ARV therapy.

Then there's the fact that she was started so late. Most of the deaths during treatment occur during the first three-to-six months; there just hasn't been enough time for the drugs to work.

At least she was comfortable. I also learned a little more about the community that develops on the ward among the patients and guardians. The woman in the bed next to Charity was from Zambia and had no guardian of her own. However she spoke English and so looked out for Charity and explained things to Charity's grandmother. Wonder if the Zambian was perhaps the same age as Charity's mom—if that's why Charity seemed less anxious whenever the Zambian woman spoke with her?

Spent much of the morning in the maternity ward with Godfrey Mdzudzuma, 32, one of four male nurses currently at Embangweni. He started off as a driver but his wife had a heart-to-heart with him about the opportunities for drivers—who are quite mobile—to have multiple girlfriends and all the risks that entails. So together they decided that he should become a nurse instead, find a place where they could both work since she is also a nurse.

Currently Godfrey's wife works at a different hospital but it looks like she'll be transferring to Embangweni in a few months. She has already given her notice.

Godfrey and Madlitso Chosalawa, another male nurse, were helping to orient Jane Chibaka, who just arrived and is on loan for a month from Ekwendeni Hospital. They spent the morning removing caesarean section sutures (no forceps to hold the sutures, Godfrey pointed out. He had to use his gloved fingers) and checking to see if some of the new moms and babies were ready to be discharged and sending them on their way after some brief education on what signs and symptoms should bring them back to the hospital right away.

Then I checked in with Lindsay Kamanga, the hospital administrator to get some more facts and figures about the place. They have between 4,500 and 5000 admissions to the hospital each year and see more than 15,000 patients in the four health centers. The operating budget for entire Embangweni health system for fiscal year 2008-2009 is 90,592,434.96 Malawian Kwacha, which works out to just over $647,000 a year. But this seems like an aspirational budget since more than a third of the income is from donations, which can fluctuate.

Just under 10% of the income comes from fees charged to patients. Mrs. K estimates that about a third of patients pay for their services, sometimes less. To give a few examples, the fee for an evacuation after miscarriage is 5000 kwacha ($35.71), for sepsis is 1745 kwacha ($12.46) and for a course of malaria treatment in the hospital is 1710 kwacha ($12.21)—although "LA" is provided free of charge by the government. LA turns out to be Co-Artem, made by Novartis.

The locum budget for the month of April was 269,529 MK for six senior nurses and 134,764.50 MK for three junior nurses, giving a total of 487,293.50 MK or $3,480. I have heard from several others that the locum pay is 800 kwacha per shift (about $5.70). (Hiring locum means hiring a nurse or clinical officer who is off-duty or on vacation to fill in.)

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

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