As I head home, I am spending time reflecting on my time in Malawi and some of the things I have learnt.
This is one of the poorest countries in the world and this is evident in many ways, not least in terms of the healthcare system. The team in QECH, Blantyre are doing amazing work but there is a limit to what they can achieve within their minimal financial resources.
Children born with cerebral palsy or other long term conditions have a profoundly different life than they would back in the UK. There is no community nursing back up, no access to feeding support such as gastrostomies or even long term nasogastric tubes. If children are unable to take full feeds orally, they will not get enough. One of the children I met on the malnutrition ward was a 9 year old with cerebral palsy. He weighed 10kg, the weight of a 1 year old at home. His wasting and stunted growth were upsetting to see. He was on the ward for one of his regular admissions for nasogastric feeding because he is unable to maintain adequate nutrition orally at home. His suck and swallow reflex is just not up to the job. The child's mother was gently trying to coax him to take some feed off a spoon, in the hope that he would be able to go home soon. I could hear that he was having trouble swallowing it and was acutely aware that he was heading for another episode of pneumonia caused by aspirating food into his lungs. Nonetheless, his mother persevered gently, uncomplainingly, lovingly. What other choice does she have?
The burns ward is full of children with extensive burns, most of their tiny bodies covered in bandages. Many of these injuries have happened at home while cooking. If you all live in one room and have to cook over an open fire in that room, accidents are almost inevitable. Adults may sometimes be burnt as a punishment for crime against the community.
The vast majority of people here have close to nothing. This was brought home to me one lunchtime when my colleagues and I were trying to provide a little thank you to the Malawi medical team by way of a few cakes after the teaching session. We had been and bought cakes and, in an attempt to minimise the use of plastic bags, had chosen to carry the cakes in their transparent containers. The decision to decline a bag was one I deeply regretted as soon as we entered the hospital grounds. There are always many people in the outside spaces, visiting family, doing their washing, preparing simple meals in communal areas. I can vividly picture the looks of disbelief and desire on some of their faces. Some of these people have never and will never eat something like that. I can't remember a time I felt more uncomfortable at a faux pas, or more acutely aware of a divide. My insensitivity has left a lasting impression. Not one person asked for cake, not that there would have been anywhere near enough to go round.
Despite having next to nothing, what little the community has is shared. It is common to see mothers coming onto wards with a bowl of nsima they have prepared and sharing it among children and mothers in the surrounding beds. If one mother buys a few pieces of fruit from a vendor by the side of the road, she will hand them round to the children in the ward, often forgoing one herself.
There's a Chichewa phrase that means "your child is my child" and this epitomises so much of what I have seen during my time in Malawi. In the Malawi culture, it is not the done thing to show emotion, except just after death. Nevertheless there is evidence of great togetherness in the community. In the wards, the sharing of small spaces and beds is obviously a comfort. Practical support such as shared cooking and laundry tasks in the hospital grounds lightens the load. Mothers sit shoulder to shoulder in times of need and crisis, drawing strength from each other's physical presence. I have been amazed by the ability of the families I have met to accept what life throws at them and been inspired by their sense of community and solidarity. I hope I have the opportunity to go back before too long.
No comments:
Post a Comment