Malawi Day 1: The adventure begins

To learn about delivering healthcare in a resource limited setting. That's the main objective of this training course in Blantyre, Malawi. I joked about this before I left home: "I work in the NHS; I know all about limited resources!". Little did I know. 





I was going to say my senses were assaulted on arrival to the hospital. That's not quite true. What happened was much gentler. Overwhelmed, yes, but not assaulted. 





Walking through the corridors of crumbling concrete, corrugated iron roofs and peeling paint is like nowhere I've ever been. Looking out the windows into the various courtyards I see lines and lines of colourful African print fabric drying in the sunshine, families sitting chatting, meals being shared, children playing. There are people everywhere but it's calm. There's a certain tranquility that defies the crowds. 





I discover later that these people outside are waiting patiently for the next visiting time so that they can tend to their loved ones, change sheets, provide a meal. The fab
ric is the clean laundry, ready for the next bed change.




Through a maze of corridors and walkways, we find the paediatric unit and are welcomed by our host as a couple of chickens cluck outside the open window. 





We're divided into pairs and my buddy and I are dispatched to the neonatal unit where we are met by a clinical officer.  This is not a role I know, but during the course of the day I learn that the unit could not survive without him. There is little he doesn't know about caring for these tiny, vulnerable infants. We join him on the first ward round of the day. 





I'm aware of a row of wooden boxes on legs lined up against the wall, and it takes me a moment to realise that these are where the babies are nursed.  On closer inspection, I see that these boxes are specially made cots with rows of light bulbs under the mattress to provide heat to these little babies. I comment on the ingenuity of these bespoke cribs and am told "we just use locally available materials".  They're making do and it really works. The babies are warm and cosy in brightly coloured traditional fabrics. 





As the round progresses, we see two babies who are both HIV and syphilis positive. Now I'm outside the comfort zone. I haven't seen a patient with syphilis before and I listen as our clinical officer patiently explains the treatment plan. Blood cultures, antibiotics and feeding support. To this end, the mothers are admitted to the ward every 2-3 hours to feed their baby and they do this with great equanimity, either from the breast or via a nasogastric tube. There are some chairs but not enough and some of them settle onto the floor with the baby on their lap. Once feeding is done, they leave the ward and the babies sleep. 





The ward round progresses and we see babies with jaundice. Treatment plans are discussed. I look around for phototherapy lamps and notice a small wooden box with multiple LEDs embedded in it. Again, this is something made using the available resources to meet a need. It's rested on the Perspex cot cover while the baby's eyes are covered with a bandage to protect from the bright light. 





Babies are reviewed and moved to the Kangaroo Care area, where babies are nursed skin-to-skin with their mothers before being ready for discharge. A couple of babies are discharged and a plan made for "bench review". Is this a new medical term? It's not something I've heard of. It becomes clear as our next stop is the bench. It's a seating area outside the ward where babies are reviewed daily or weekly to check progress. There's not really an appointment but mothers wait their turn patiently. And this epitomises the feel of the whole place. There is waiting, there is hoping and there is making do. All the while there is acceptance and there is calm.