I am woken at dawn by the muezzin from the Lilongwe mosque and prevented from getting back to sleep by the cleaners, whose stockroom is on the same floor, not long after starting work with a great deal of bucket clattering..
We are staying in the Lilongwe Hotel, which is part of a chain run by the government. The staff are lovely even if the hotel is a little more rough and ready. There are candles by the bed because of power cuts and the TV reception is too poor for me to enjoy African Magic, a channel made up of African pop videos and moralistic soap operas.
I have no idea what to expect from our visit to Bwaila Hospital, until very recently.known as Bottom Hospital - originally because it was at the bottom of the hill, but also because, according to legend, only blacks, the bottom of society, were sent there under British rule. Colonials went to the Kamuzu hospital at the top of the hill..........
Shenard comes with us to make introductions to the principal nursing officer Jennifer Chinsenga and her deputy Modesta Kauduka, who seem nervous about our visit........
Arriving at the hospital feels like arriving at a village, albeit without the singing and dancing. There are dozens of people, largely women, sat about in the shade. After visiting one of the maternity unit's two wards we can see why; it is so crowded that being outside is the only chance for a bit of fresh air........
Alex reckons it is the cleanest African hospital he has ever visited but the most disturbing thing is how packed in everybody is. Women in various stages of pregnancy, labour and with their babies are lined up in corridors and in overflowing wards and labour rooms. There is hardly any room between beds and the labour wards are often so full, we are told, that women must go through early labour or even give birth on the floor.
There is a poster on the labour room door exhorting husbands to support their wives while in labour, but in reality it is too crowded to allow men in as there would not be enough privacy for the women.
They have had six babies born since the shift started at 7.30 and it is only 10.45. Up to 40 babies a day are born at the hospital and the pressure on beds means that women can only stay for two days after delivering. Even after a c-section, if they need more care they must go to another hospital after that........
Unsurprisingly the labour ward is hectic, with one woman without curtains round her bed moaning in pain as a number of people (there are lots of nursing students here) try to comfort her.
At this point I think I am going to cry. We move on to the intensive care unit for premature babies. The smallest two are about 2lbs, are wrapped in bright African cloth. There is no equipment and only one nurse. The babies are two to a cot with heat lamps above them. Some are in incubators (known as boxes) but there is no oxygen going into them..........
The two (male) obstetricians on the ward look extremely harassed while the nurses look as calm as anyone could in such circumstances. After what we heard from Dorothy yesterday this is probably down to being worn and resigned to their circumstances. There are 30 nurses to cover the whole unit, which last year had 25 maternal deaths and lacks enough even basic equipment, such as cord clamps, sutures and saline drips...
We talk to one nurse in her fifties, Filipina, who tells us that she has done a night shift at the hospital's physical disability unit before doing a shift here. Alex talks to another who says that she arrived at the hospital on Tuesday and plans to work until Friday. Her children are having to fend for themselves.
While Claire and I talk to Filipina, who has an ill husband, three grandchildren and five other children to care for, Karen and Alex talk to Esther, a cleaner at the hospital who is wearing an anti Edzi (AIDS) t shirt. She is HIV positive. Although cleaners at the hospital also help the mothers learn how to breastfeed she only earns 5000 kwacha a month........
I wish I could give all of the nurses here some cash but they tell us that going and telling people what conditions are like will be just as helpful.
The afternoon brings more contrast when we visit a project run by the Lighthouse Trust at Kamuzu Hospital. The hospital itself is less chaotic than Bwaila and the trust building is completely different; modern, purpose built and cool with a children's play area and planted courtyard. Funded by a number of NGOs, it offers comprehensive HIV/AIDS testing, counselling and day treatment.
They are clearly used to international visitors and the director Enous Chang'ana gives a brisk tour. Clients can get counselling, followed by their HIV test results - available in just 15 minutes - have health checks, be prescribed antiretrovirals and food supplements, get advice from the National Association of People Living with HIV and AIDS and have day treatment if, for example, they are dehydrated, under one roof.
It is an admirably professional operation. They have no truck with the strictly demarked roles found elsewhere in Malawi healthcare and have a series of tricks for following up do-not-attends; an army of volunteers works in the community and can track clients down with the maps clients are obliged to leave of their village............................
The trust says the government is in no position to offer state-funded care on the level they can offer and indeed they train government staff in counselling and training. It is worlds away from what is on offer in much of the country but the stricken faces of clients who have just been diagnosed positive - photos are forbidden because of the stigma - tell their own story. At least here they will receive decent care......
Back at the Oxfam office we meet Abbey, the photographer hired by Oxfam to accompany Alex - he has been commissioned to write pieces on food aid, climate change and orphans in addition to the healthcare story. She goes off in hunt of photographs while we present Shenda, Catherine and Patrick with some presents to say thank you - including a very large tip for Patrick, who has been a massive boon to the whole trip...............
At dinner Alex and Abbey swap stories about the places they have visited. Alex reported from Sierra Leone and worked for Oxfam after the tsunami; until recently he was based in Thailand and his TV producer wife was in Rwanda during the genocide. Abbey used to work for the Telegraph and tells us about going to Rwanda for their Christmas appeals and to Iraq after the invasion. She got back from spending three months in the Yemen with Oxfam just a few weeks ago. Somehow visits to NHS trusts do not compare and my career feels terribly dull in comparison.
No comments yet