Saturday, July 26, 2008

Success Creates Its Own Problems

3 July 2008, Thursday

Morning report at about 8:40 PM. Tagged along with Catherine Ndolo again. Watched her prepare the operating theatre for an endoscopy. Getting the equipment ready, making sure there was sterile gauze available. The whole room illuminated by natural light. Really quite amazing. There are fluorescent lights overhead and a round surgical lamp. The clock on the wall is stuck at ten past five and hasn't moved since I've been here.

The patient is a Mrs. Jere (a very common last name), who has been complaining of pain after eating for the past year. She has been to the district hospital at Kasungu but they keep sending her away. She decided to get herself to Embangweni to see if they could get to the bottom of things. In other words, she preferred going to a hospital in a rural area, which is at the end of a 45-minute ride on a dirt road, rather than to a nearby hospital on a tarmac road.

In fact, another woman who came in on Monday had an ectopic pregnancy, which was missed at Kasungu Hospital. They performed an ultrasound and said that the pregnancy was proceeding normally. She referred herself to Embangweni, where the ectopic pregnancy was diagnosed and taken care of.

These self-referrals from outside Embangweni's catchment area have placed a major strain on the hospital. Because of course by the time people get here after having been at another hospital, they are in much worse shape and require a great deal more attention and effort to save their lives.

The past four months have been particularly bad due to a critical lack of clinical officers. Apparently, many hospitals have been offering top-ups to clinical officers on their own authority—not as a matter of Ministry of Health policy but as a matter of survival—and so they are getting poached out of the rural areas. One clinical officer who was supposed to come yesterday during his month leave to help bail out Embangweni was forbidden to do so by his home hospital when they found out. He has told to help them out instead.
The nursing shortage continues to be chronic but at this moment, the lack of clinical officers is the crisis.

Yesterday's Malawi Daily Times had an article about a new team of doctors who have just arrived from the People's Republic of China and will be headed to the central hospitals in Lilongwe (where I had visited the pediatric ward) and Mzuzu.

Previously the Mzuzu Central Hospital had been staffed by doctors from Taiwan. But when Malawi switched diplomatic status from Taiwan to the People's Republic, the Taiwanese doctors left and the Taiwanese programs were suspended. I've heard from a couple of people the doctors at Mzuzu were given 48 hours to leave—although it's not clear by whom.

And ever since then the Mzuzu hospital—one of only a handful of central hospitals in the country and perhaps the only central hospital the north (I'm not clear on this)—was basically non-functional. In any event, it's the central hospital to which Embangweni ultimately refers (after the district hospital in Mzimbe).

Here's what The Daily Times article had to say:

Chinese ambassador to Malawi Lin Songtian said the team would be in the country for six months but said another team would arrive after agreements and documents were signed between the two countries.

The ambassador said that on a recent visit to Mzuzu Central Hospital, he found deplorable conditions, especially in the maternity wing so he requested his government to send over a team before agreements were finalized.

"Mzuzu was our first priority because as you know, our brother Taiwan had a team there helping out so when they left, people were left destitute," he said.

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


Dean Miller said...

How in the Hell do you MISS an ectopic?
Oh Christine, this is killing me.

Christine Gorman said...

Makes you realize why maternal death rates are so high--1 mother dies for every 100 live births in Malawi. At Embangweni, the rate is 1 in 600. That's still high but better than the national average.